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Bitesize evidence: ACE inhibitors effective in coronary artery disease

Q Are ACE inhibitors effective in decreasing

mortality and morbidity in patients with

coronary artery disease but without heart failure or systolic dysfunction?


The French authors conducting this meta-analysis searched four databases, secondary sources and presentations at scientific meetings. They did not look for unpublished research.

They included all randomised controlled studies of at least two years' duration of patients with coronary artery disease (or at high risk of it) but without signs or symptoms of heart failure and no documented left ventricular dysfunction.

The authors did not state whether the literature search and data abstraction were performed by more than one person, which is the usual technique in meta-analysis. They combined the results from seven studies enrolling a total of 33,960 patients. Five different ACE inhibitors were used in these studies.

Overall mortality was lower in patients receiving an ACE inhibitor than in those receiving placebo, though the effect on the individual was small (NNT for two years = 419; 95 per cent CI 279-839). Deaths due to cardiovascular effects were also decreased (NNT for two years = 720; 507-1,370). Myocardial infarction risk and stroke risk were similarly decreased.

These NNTs are so high because of the relatively small benefit (12 per cent to 14 per cent reduction) and because the death rate in these studies was less than 2 per cent. There was no correlation between blood pressure reduction and the outcomes seen in this study.

Level of evidence

1a (see


Danchin N et al. ACE inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction. Arch Intern Med 2006;166:787-96.

Bottom line

ACE inhibitors decrease overall mortality, cardiovascular mortality, myocardial infarction risk and stroke risk in patients with coronary artery disease but without signs or symptoms of heart failure. The benefit is not pronounced, with only one death prevented in more than 400 patients treated for two years.

This Patient Oriented Evidence that Matters (POEMs) is taken from InfoPOEMS/Inforetriever, a point of care evidence-based medicine tool, published by John Wiley. For more information

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