Beyond remodeling: A new paradigm for angiotensin-converting enzyme inhibitors following myocardial infarction

Angiotensin converting enzyme (ACE) inhibitors, originally designed to trea t hypertension, were quickly demonstrated to confer hemodynamic and surviva l benefit to patients with congestive heart failure. Extending this paradig m to patients with left ventricular dysfunction (LVD) post-myocardial infar ction (MI), ACE inhibitors were shown to attenuate ventricular remodeling a nd reduce mortality. An unexpected finding that ACE inhibitors could reduce the incidence of myocardial infarction, prompted enormous interest in thei r anti-ischemic potential. Indeed, a significant body of experimental liter ature supports the concept that ACE inhibitors have direct anti-atheroscler otic and anti-ischemic effect. Recent clinical trials have shown that ACE i nhibitors confer significant protection from ischemic events.