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. |