ACE inhibitors should be routinely used in patients with left ventricular dysfunction or heart failure, researchers have concluded (Lancet 2000;355:1575). For those with heart failure, treatment should be given regardless of whether the patient has had a recent myocardial infarction.
Dr Marcus Flather (preventive cardiology and therapeutic research program, McMaster university, Hamilton, Canada) and colleagues have reported the results of a systematic overview of five randomised trials. A total of 12,763 patients, randomly assigned treatment or placebo for 35 months, were included in the overview. Following ACE inhibitor treatment, a 28 per cent reduction in death, myocardial infarction and hospital admission for heart failure in patients with left ventricular dysfunction or heart failure was recorded.
The benefits on mortality were observed soon after the start of treatment and persisted long term, the researchers say. They estimate that about 60 deaths would be avoided for every 1,000 patients treated with an ACE inhibitor.
They also comment:"Use of ACE inhibitors after an acute myocardial infarction provides clear benefit to a wide range of patients. Those at high risk, especially with clinical heart failure or left ventricular dysfunction, can expect substantial reductions in mortality and morbidity. ACE inhibitors should, therefore, be routinely used long-term in all eligible high-risk patients."