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Curriculum Update #3

• Clinical Trials Update: Tissue ACE inhibition offers new hope for treating cardiovascular disease

This Curriculum Update highlights important recent trials of tissue ACE inhibition in patients with cardiovascular disease and preserved left ventricular function. These trials suggest a new rationale for selecting ACE inhibitor therapy based on the agent's tissue-ACE affinity. The approach offers the potential to improve vascular pathology and significantly reduce the risk of cardiovascular morbidity and mortality.

Introduction

The contents of this Curriculum Update represent a concise overview concerning the emerging field of the endothelium and its role in cardiovascular health and disease. The curriculum focuses on recent clinical trials, which have demonstrated that angiotensin-converting enzyme (ACE) inhibition reduces mortality and cardiac events in patients with cardiovascular disease and normal left ventricular (LV) function, whether or not they have hypertension.

This Curriculum Update explores the following topics:

  • The role of the renin-angiotensin system and tissue ACE in endothelial function
  • The vasculoprotective effects of tissue ACE inhibition
  • Data from recent trials using inhibitors with good tissue potency in patients with coronary artery disease and normal LV function: TREND, BANFF, QUO VADIS, QUIET, HOPE
  • The implications of the tissue ACE trials for clinical practice: How tissue ACE avidity of an ACE inhibitor may affect clinical outcomes

This slide curriculum begins by examining the role of the renin angiotensin system and tissue ACE in endothelial dysfunction. It further provides an update on the latest clinical trials of tissue ACE inhibition that are advancing treatment and prevention of cardiovascular disease.



Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine. Supported by an unrestricted educational grant from Parke-Davis, a Division of Warner-Lambert Company.

Copyright © 2000.

The editorial content of this program expresses the views of the individual contributors and does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, Parke-Davis, or the publisher. The indications and dosages of drugs discussed in this program may vary from those approved by the Food and Drug Administration (FDA). The reader is advised to consult the full prescribing information for each medication prior to use.


Program Outline

Download CU3.ppt (19 slides - 1.1MB)

Program Outline Causes and consequences of endothelial dysfunction: A unifying model Endothelial function predicts cardiovascular events: 5-year follow-up in angina patients Role of ACE and ACE inhibition Circulating vs tissue ACE Vasculoprotective effects of tissue ACE inhibition JNC VI guidelines: Compelling indications and treatment choices for hypertension therapy Tissue ACE trials in patients with CAD and preserved LV function Relative avidity of ACE inhibitors in plasma and tissue TREND: Endothelial function and ACE inhibition BANFF: Absolute changes in FMD QUO VADIS: Effects of quinapril on ischemia QUIET: Cardiac death, nonfatal MI, or VT/VF QUIET: Effect of quinapril on CAD progression according to LDL-C level HOPE: Scope of the trial HOPE: Risk reduction with ACE inhibition Tissue ACE trials in patients with CAD and preserved LV function: Benefits observed Tissue ACE trials in patients with CAD and preserved LV function: Implications for clinical practice Summary

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Related at vwbg.org

Vascular Biology in Clinical Practice © Vol. 1, No. 4

Clinical trials update: Tissue ACE inhibition offers new hope for treating cardiovascular disease

Advances in vascular biology bring physicians the opportunity to apply new concepts in the treatment of patients with cardiovascular disease.

HOPE: New validation for the importance of tissue ACE inhibition

The results of the recently published HOPE (Heart Outcomes Prevention Evaluation) study provide powerful confirmation of the clinical benefits of tissue angiotensin-converting enzyme (ACE) inhibition, now strikingly demonstrated in patients at high risk for cardiovascular events.

Decrease in PAI-1 antigen is greater with ACE inhibition

Plasminogen activator inhibitor-1 (PAI-1) is a known risk factor for cardiovascular (CV) disease and myocardial infarction (MI).
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