Emerging RoleofAngiotensin-Converting EnzymeInhibitors inCardiac andVascular Protection

summaryof35 clinical trials ofACEinhib-itors in patients with chronic heart failure and/or left ventricular dysfunction (R. Garg, S. Yusuf, personal communication). Trials other than the SOLVD trialsweresmallandofshortduration (generallyonly for3 to 6 months). Overall, a significant reduction in the inci-denceof myocardial infarction was noted, but most endpointswere derivedfromthe SOLVDtrials (RR, 19%; 95% CI, 0%to 35%). Intrials otherthan SOLVD, 2023 patients were randomized to receive an ACEinhibitorand 1568 to the control group. There were 26 myocar-dial infarcts in theACEinhibitor-treatedgroup (1.3%) versus 24 in the control group (1.5%). The evidence provided by the SOLVDand SAVEtrials suggests theintriguing possibility that the reduction in ischemicevents may occur in a broader group of high-risk patients such as those with preserved left ventricular ejection fraction. However, such patients may not havesignificant increases in the systemic levels of renin152and angiotensin, although