ace inhibitors ± aspirin: clinically important benefits

Inpharma 1359 - 12 Oct 2002 ACE inhibitors ± aspirin: clinically important benefits ‘In the absence of all clear contraindications, concomitant use of aspirin and ACE inhibitors should be considered in all patients at high risk of major vascular events’, say investigators from the multinational ACE Inhibitors Collaborative Group. This is their conclusion after undertaking a systematic review of data from 22 060 patients at high risk of cardiovascular events who were involved in 6 long-term, randomised placebo-controlled trials of ACE inhibitors, each of which assessed the clinical effects of ACE inhibitor therapy with and without aspirin on major clinical outcomes [composite of death, myocardial infarction (MI), stroke, hospital admission for congestive heart failure, or revascularisation]. * Except for SOLVD, results from analyses of all trials showed that there were no significant differences between the proportional reductions in risk with ACE inhibitor therapy in the presence or absence of aspirin for the major clinical outcomes, or in any of its individual components, except MI. Overall, the risk of the combined outcome of major vascular events was significantly reduced by 22% with ACE inhibitor therapy, with clear reductions in risk among patients receiving aspirin at baseline (odds ratio 0.8; 99% CI 0.73–0.88) and among those who were not (0.71; 0.62–0.81). The investigators conclude that, while their analysis cannot rule out the possibility of some sort of interaction between aspirin and ACE inhibitor therapy, the data ‘show unequivocally that even if aspirin is given, the addition of ACE inhibitor therapy produced substantial additional benefit in all major vascular outcomes’. * The analysis included the Studies of Left Ventricular Dysfunction (SOLVD) Treatment and Prevention trials, the Acute Infarction Ramipril Efficacy (AIRE) trial, the Survival and Ventricular Enlargement (SAVE) trial, the Trandolapril in patients with reduced left ventricular function after acute myocardial infarction (TRACE) trial, and the Heart Outcomes Prevention and Evaluation (HOPE) trial. Teo KK, et al. Effects of long-term treatment with angiotensin-converting-enzyme inhibitors in the presence or absence of aspirin: a systematic review. Lancet 360: 1037-1043, 5 Oct 2002 800901799 1 Inpharma 12 Oct 2002 No. 1359 1173-8324/10/1359-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Inpharma 1359 - 12 Oct 2002

ACE inhibitors ± aspirin: clinicallyimportant benefits

‘In the absence of all clear contraindications,concomitant use of aspirin and ACE inhibitors should beconsidered in all patients at high risk of major vascularevents’, say investigators from the multinational ACEInhibitors Collaborative Group.

This is their conclusion after undertaking a systematicreview of data from 22 060 patients at high risk ofcardiovascular events who were involved in 6 long-term,randomised placebo-controlled trials of ACE inhibitors,each of which assessed the clinical effects of ACEinhibitor therapy with and without aspirin on majorclinical outcomes [composite of death, myocardialinfarction (MI), stroke, hospital admission for congestiveheart failure, or revascularisation].*

Except for SOLVD, results from analyses of all trialsshowed that there were no significant differencesbetween the proportional reductions in risk with ACEinhibitor therapy in the presence or absence of aspirinfor the major clinical outcomes, or in any of its individualcomponents, except MI. Overall, the risk of thecombined outcome of major vascular events wassignificantly reduced by 22% with ACE inhibitor therapy,with clear reductions in risk among patients receivingaspirin at baseline (odds ratio 0.8; 99% CI 0.73–0.88)and among those who were not (0.71; 0.62–0.81).

The investigators conclude that, while their analysiscannot rule out the possibility of some sort of interactionbetween aspirin and ACE inhibitor therapy, the data‘show unequivocally that even if aspirin is given, theaddition of ACE inhibitor therapy produced substantialadditional benefit in all major vascular outcomes’.* The analysis included the Studies of Left Ventricular Dysfunction(SOLVD) Treatment and Prevention trials, the Acute InfarctionRamipril Efficacy (AIRE) trial, the Survival and Ventricular Enlargement(SAVE) trial, the Trandolapril in patients with reduced left ventricularfunction after acute myocardial infarction (TRACE) trial, and the HeartOutcomes Prevention and Evaluation (HOPE) trial.

Teo KK, et al. Effects of long-term treatment with angiotensin-converting-enzymeinhibitors in the presence or absence of aspirin: a systematic review. Lancet 360:1037-1043, 5 Oct 2002 800901799

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