Interventions that may influence the course of CAD. Part I: ACE inhibitors, calcium antagonists, and lipid-lowering agents

Results from recent studies indicate that several classes of drugs appear to alter the course of coronary artery disease (CAD) and/or decrease adverse clinical events. Emerging data suggest that angiotensin-converting enzyme (ACE) inhibitors used in patients with left-ventricular (LV) dysfunction or acute myocardial infarction (MI) may prevent CAD-related events, such as recurrent MI, death or unstable angina, or post-infarction need For revascularization. This protective effect may be present in patients without LV dysfunction; several trials designed to confirm or refute this are underway. Also, some clinical data suggest that dihydropyridine calcium antagonists attenuate early lesion progression in CAD patients, and several calcium antagonists have been shown to alter experimental atherosclerosis. Quantitative angiographic trials have demonstrated that lipid-lowering agents slow atherosclerotic lesion progression and reduce acute coronary outcomes. A recent large clinical trial showed a marked benefit of lipid lowering therapy on total mortality and other adverse outcomes in CAD patients.