Angiotensin-converting enzyme (ACE) inhibitors are effective drugs that have been
shown to lower morbidity and mortality in patients with heart failure who have left
ventricular systolic dysfunction.
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2
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- Pfeffer M.A.
- Braunwald E.
- Moye L.A.
- Basta L.
- Brown E.J.
- Cuddy T.E.
- Davis B.R.
- Geltman E.M.
- Goldman S.
- Flaker G.C.
- et al.
Effects of captopril on mortality and morbidity in patients with left ventricular
dysfunction after myocardial infarction results of the Survival and Ventricular Enlargement Trial.
N Engl J Med. 1992; 327: 669-677
3
Patients with congestive heart failure (CHF) often have indications for using both
ACE inhibitors and antiplatelet agents. Various clinical trials have suggested that
an adverse interaction exists from the combined use of aspirin and an ACE inhibitor
in patients with CHF, but few studies have measured this effect directly.
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The most compelling evidence of a potential adverse interaction between ACE inhibitors
and aspirin stems from the Studies Of Left Ventricular Dysfunction (SOLVD)
1
,
10
and Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)
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trials. In SOLVD, although enalapril and aspirin when used alone were associated
with lower mortality rates, retrospective analysis revealed that the addition of enalapril
did not reduce mortality in patients already taking aspirin, and conversely, neither
did the addition of aspirin in patients receiving enalapril. In a post hoc analysis
of CONSENSUS II, aspirin and enalapril, when utilized alone, were associated with
lower mortality rates. However, the relative risk of death at the end of the study
was 1.23 (95% confidence interval [CI] 0.99 to 1.53) for patients taking aspirin and
enalapril, and 0.86 (95% CI 0.63 to 1.16) for patients taking enalapril without aspirin
(p = 0.047). Guazzi et al,
7
in a small prospective study, measured maximal exercise oxygen uptake (VO2max) in patients with CHF, and demonstrated an adverse effect when ACE inhibitors
were combined with aspirin, but not with ACE inhibitors alone. Therefore, we hypothesized
that exercise duration and VO2max would not be attenuated by clopidogrel compared with aspirin in patients with
CHF who are taking ACE inhibitors.To read this article in full you will need to make a payment
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References
- Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.N Engl J Med. 1991; 325: 293-302
- Effects of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.N Engl J Med. 1992; 327: 669-677
- Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure.Lancet. 1993; 342: 821-828
- Counteraction of the vasodilator effects of enalapril by aspirin in severe heart failure.J Am Coll Cardiol. 1992; 20: 1549-1555
- Acute hemodynamic interaction of aspirin and ticlopidine with enalapril.Circulation. 1998; 98: 757-765
- Improvement of alveolar-capillary membrane diffusing capacity with enalapril in chronic heart failure and counteracting effects of aspirin.Circulation. 1997; 95: 1930-1936
- Aspirin worsens exercise performance and pulmonary gas exchange in patients with heart failure who are taking angiotensin-converting enzyme inhibitors.Am Heart J. 1999; 138: 254-260
- Comparison of changes in respiratory function and exercise oxygen uptake with losartan versus enalapril in congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.Am J Cardiol. 1997; 80: 1572-1576
- Effect of angiotensin-converting enzyme inhibitors on endothelium-dependent peripheral vasodilation in patients with chronic heart failure.J Am Coll Cardiol. 1994; 24: 1321-1327
- Antiplatelet agents and survival.J Am Coll Cardiol. 1998; 31: 419-425
- Interaction between enalapril and aspirin on mortality after acute myocardial infarction.Am J Cardiol. 1997; 79: 115-119
- Interaction of ACE inhibitors and aspirin in patients with congestive heart failure.Ann Pharmacother. 1999; 33: 375-377
Kraemer HC, Thiemann S. How many subjects? In: Kraemer HC, Thiemann S, eds. Statistical Power Analysis in Research. Newbury Park: Sage Publications, 1988:101, 105–112
- Prostaglandins in severe congestive heart failure. Relation to activation of the renin-angiotensin system and hyponatremia.N Engl J Med. 1984; 310: 347-352
- Contribution of prostaglandins to the antihypertensive action of captopril in essential hypertension.Hypertension. 1981; 3: 168-173
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Article info
Publication history
Accepted:
February 19,
2003
Received in revised form:
February 19,
2003
Received:
August 23,
2002
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
