Consider The Evidence: Med/Peds Journal Roundup

August 23, 2006

Even more uses for ACE-I’s

Filed under: cardiovascular, hypertension, lancet — medblog @ 7:14 am

Lancet 8/19 – Updated guidelines for Abdominal Aortic Aneurysm screening were put out by USPTF last year reccommending ultrasound in men aged 65-75 who have ever smoked, especially due to the mortality and lack of medical treatment options for the disease. Clearly endovascular pathology related to atheroma and smoking are somehow involved. with AAA.
Enter ACE-inhibitors, which seem to be showing evidence of vasoprotective effects through some modulation of the renin-angiotensin system – also thought to be involved somehow with vascular pathology.

Hackam et al. publish a retrospective observational study in the current Lancet, investigating the use of ACE-I’s in patients with AAA. They analyzed records of 15,000 patients hospitalised with a primary diagnosis of abdominal aortic aneurysm in Canada. The researchers found that patients receiving ACE inhibitors before admission were significantly less likely to present with aortic rupture.(Adjusted Odds Ratio: 0.83) They conclude that the beneficial effect of such drugs is independent from their antihypertensive properties, because use of other antihypertensive agents was not associated with a lower risk of AAA. Clearly the study comes with all of the shortcomings of a retrospective study, and although we cannot conclude a causal effect, RCTs are warranted.

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