Jugdutt Bodh I
Walter Mackenzie Health Sciences Centre, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Vasc Health Risk Manag. 2006;2(2):125-38. doi: 10.2147/vhrm.2006.2.2.125.
Survivors of myocardial infarction (MI) are at high risk of disability and death. This is due to infarct-related complications such as heart failure, cardiac remodeling with progressive ventricular dilation, dysfunction, and hypertrophy, and arrhythmias including ventricular and atrial fibrillation. Angiotensin (Ang) II, the major effector molecule of the renin-angiotensin-aldosterone system (RAAS) is a major contributor to these complications. RAAS inhibition, with angiotensin-converting enzyme (ACE) inhibitors were first shown to reduce mortality and morbidity after MI. Subsequently, angiotensin receptor blockers (ARBs), that produce more complete blockade of the effects of Ang II at the Ang II type 1 (AT1) receptor, were introduced and the ARB valsartan was shown to be as effective as an ACE inhibitor in reducing mortality and morbidity in high-risk post-MI survivors with left ventricular (LV) systolic dysfunction and and/or heart failure and in heart failure patients, respectively, in two major trials (VALIANT and Val-HeFT). Both these trials used an ACE inhibitor as comparator on top of background therapy. Evidence favoring the use of valsartan for secondary prevention in post-MI survivors is reviewed.
心肌梗死（MI）幸存者面临着较高的残疾和死亡风险。这是由于梗死相关并发症，如心力衰竭、伴有进行性心室扩张、功能障碍和肥大的心脏重塑，以及包括室性和房颤在内的心律失常。肾素-血管紧张素-醛固酮系统（RAAS）的主要效应分子血管紧张素（Ang）II是这些并发症的主要促成因素。首次证明，使用血管紧张素转换酶（ACE）抑制剂抑制RAAS可降低MI后的死亡率和发病率。随后，引入了血管紧张素受体阻滞剂（ARB），其在1型血管紧张素II（AT1）受体处对Ang II的作用产生更完全的阻断，并且在两项主要试验（VALIANT和Val-HeFT）中，ARB缬沙坦分别在伴有左心室（LV）收缩功能障碍和/或心力衰竭的高危MI后幸存者以及心力衰竭患者中，显示出与ACE抑制剂在降低死亡率和发病率方面同样有效。这两项试验均在背景治疗基础上使用ACE抑制剂作为对照。本文综述了支持在MI后幸存者中使用缬沙坦进行二级预防的证据。
