Focusing on coronary artery disease

This month’s edition of Cardiology Review has a definite emphasis on coronary artery disease. Our first 2 articles are in the CAD section and deal with the effects of angiotensin-converting enzyme inhibitors (ACEIs). The first is from Dr Louis Pilote, from Canada. She reports on patients over the age of 65 who have an acute myocardial infarction and are being treated with ACEIs. Of the 6 different ACEIs that are being compared, ramipril was the best. As I point out in a commentary to that article, even with the limitations of this study it is valuable in raising the possibility of a lack of class effect in this group of drugs. In the second article, Dr Mouaz H. Al-Mallah reports on the results of a meta-analysis designed to evaluate the usefulness of ACEIs in patients with coronary artery disease and preserved left ventricular (LV) function, since they are already known to be effective in similar patients with LV dysfunction. The total number of patients in randomized, placebo controlled trials suitable for analysis was 33,500 and Dr Al-Mallah’s finding demonstrated a definite—albeit modest—effect on reducing various cardiovascular end-points. Drs Peter Buttrick and Stacie Luther comment for Cardiology Review. Finally, an article in the hypertension section is concerned with the reported phenomenon of a parodoxical increase in cardiac events when the diastolic blood pressure is reduced too much by drugs. Dr Sripal Bangalore and associates evaluated the basis for this so called “J-curve” in 22,576 patients with both hypertension and coronary artery disease who formed the database of the multinational INVEST trial. They found that the risk for death and myocardial infarction—but not strokes—did indeed increase with excessive reductions in diastolic pressure. Drs John Maesaka and Bill Miyawaki comments on these findings.