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| Slide Lecture Programs |
| 2000 Core Curriculum |
| The endothelium: New insights into the origins and treatment of CAD |
August 31, 2000
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| II: |
Interactions of the RAS: ACE and the angiotensin II and bradykinin pathways |
Slide 25 |
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Potential benefits of suppressing cardiac ACE
- The efficacy of ACE inhibition in improving symptoms and survival in patients with heart failure has been attributed, as least in part, to suppression of cardiac ACE.20
- The exact mechanisms continue to be explored, but the fact that ACE inhibitors have demonstrated greater efficacy in this setting than conventional vasodilators or antihypertensive agents implies a benefit that goes beyond preload and afterload reduction, and quite possibly includes direct positive effects on myocardial function and metabolism.
- ACE inhibitors also have anti-ischemic effects, possibly resulting from direct coronary vasodilation and improvement in myocardial flow, and reduction in sympathetic stimulation and norepinephrine-mediated vasomotion.21 There may also be an effect of bradykinin on coronary tone and myocardial metabolism.
- Studies have demonstrated the benefits of ACE inhibitors in postinfarction cardioprotection. These effects include reduced infarct size,22 improved myocyte energy utilization and metabolism, and reduced reperfusion arrhythmias.23, 24
- Clinical investigations have shown a reduced incidence of ventricular arrhythmias in patients with severe congestive heart failure who are treated with ACE inhibition, and a decrease in left ventricular size following myocardial infarction (MI).25
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