The Pharmaceutical Journal
Vol 269 No 7219 p517
12 October 2002

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The Lancet (www.thelancet.com)

Evidence that ACE inhibition is affected by aspirin is weak

Concomitant use of aspirin and angiotensin-converting enzyme (ACE) inhibitors should be considered in all patients at high risk of major vascular events, say researchers (Lancet 2002;360: 1037).

Previous research has suggested that ACE inhibitors may be less effective in patients who also receive aspirin for the treatment of cardiovascular disease.

Professor Koon Teo of McMaster University, Hamilton, Canada, and colleagues systematically reviewed data from six long-term randomised trials of ACE inhibitors involving around 22,000 patients.

With the exception of one trial, the efficacy of ACE inhibitors was not found to be altered, either positively or negatively, among patients who were also receiving aspirin. Overall, ACE inhibitor therapy reduced the risk of the major clinical outcomes by 22 per cent (P<0.0001). The reductions in risk were clear for both those patients receiving aspirin at the start of the trials and those who were not, the researchers add.

"Even though results from the present analyses cannot rule out the possibility of some sort of interaction, they show unequivocally that, even if aspirin is given, the addition of ACE inhibitor therapy produced substantial additional benefit in all major vascular outcomes. Therefore, in the absence of clear contraindications, concomitant use of aspirin and ACE inhibitors should be considered in all patients at high risk of major vascular events," the researchers conclude.