Angiotension-converting enzyme inhibitors may reduce cardiovascular risk and risk of death in patients with coronary artery disease, according to a new analysis of previously conducted clinical trials reported in the April 10 issue of the Archives of Internal Medicine.

Previous research had shown that angiotensin-converting enzyme inhibitors can help treat patients with coronary artery disease or congestive heart failure. However, studies on the use of angiotensin-converting enzyme inhibitors in patients with coronary artery disease but without heart failure or left ventricle dysfunction had conflicting results.

Nicolas Danchin, MD, FESC, Hopital Europeen Georges Pompidou, Paris, and colleagues analyzed seven previous randomized and controlled trials of angiotensin-converting enzyme inhibitors in patients with coronary artery disease.

The studies tested five different angiotensin-converting enzyme inhibitors and included a total of 33,960 patients, who were followed for a minimum of two years and an average of 4.4 years. In each trial, some patients randomized to angiotensin-converting enzyme inhibitors and others to placebo.

When the results of all trials were analyzed together, treatment with angiotensin-converting enzyme inhibitors significantly reduced the risk of death from any cause, cardiovascular death, myocardial infarction, and stroke.

The researchers also found that in studies that measured additional outcomes, angiotensin-converting enzyme inhibitors appeared to reduce the risk of onset of diabetes, hospitalization for congestive heart failure, and cardiac arrest.

“In this overview of randomized trials of angiotensin-converting enzyme inhibitors for the long-term secondary prevention of coronary artery disease in patients without left ventricular dysfunction or heart failure, active treatment was associated with a highly significant reduction in all-cause mortality and all major cardiovascular events,” the authors concluded. “These results, along with those previously reported in patients who have coronary artery disease with left ventricular dysfunction or heart failure, suggest that angiotensin-converting enzyme inhibitor therapy should be systematically used in all patients with documented coronary artery disease.”