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ACE Inhibitors Do Not Show Added Benefit in Patients With Stable Coronary Artery Disease 

November 7, 2004

By Ashley Starkweather, B.S. and Asher Kimchi M.D.

New Orleans, LA– The results of the PEACE trial, a double-blind, placebo-controlled study of 8,290 patients, showed that there was no additional benefit of adding ACE inhibitors to the therapies of patients with stable coronary artery disease. These results were presented by Dr. Marc Pfeffer, M.D., of Brigham and Women’s Hospital in Boston, MA, at the meeting of the American Heart Association, and will be published in the November 11, 2004 issue of the New England Journal of Medicine 

ACE inhibitors have been shown to be of benefit in patients with systolic heart failure or left ventricular systolic dysfunction, and has become a key component of treatment for this patient population.  

The goal of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) trial, however, was to test whether the addition of ACE inhibitor therapy to standard therapy would reduce the rate of myocardial infarction, cardiovascular death, or revascularization in low risk patients with stable coronary artery disease and normal or slightly reduced left ventricle function. 

Patients were randomized from November 1996 to June 2000, and followed for up to 7 years (median, 4.9 years). 8,290 patients were enrolled, 4,158 of whom received the ACE inhibitor trandolapril, and 4,132 of whom received matching placebo. The characteristics of each patient group were very similar, with a mean age of 64 years, 18 percent were female, and 92 percent were Caucasian. Past medical history and current medications were also matched. 

The primary end point included death from cardiovascular causes, nonfatal myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Secondary endpoints were death from noncardiovascular or unknown cause, and death from any cause. 

The incidence of the primary end point was 22.5 percent in the placebo group, and 21.9 percent in the trandolapril group. No benefit was observed in the treatment group compared to the placebo group even when adjustments were made for baseline characteristics or past medical history. 

In regard to the secondary endpoints, no significant benefit was seen in the treatment group. Diabetes and congestive heart failure did develop in fewer of the trandolapril patients than in the placebo group, however. 

In conclusion, the PEACE trial demonstrates that in a patient population that has stable coronary artery disease and is receiving standard intensive therapy, including lipid lowering agents and revascularization, there appears to be no evidence of cardiovascular benefit from the addition of ACE inhibitor therapy. 

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