Coppola Giuseppe, Romano Giuseppe, Corrado Egle, Grisanti Rosa Maria, Novo Salvatore
Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, University Hospital P. Giaccone of the University of Palermo, Via del Vespro 127, Palermo, Italy.
Vasc Health Risk Manag. 2008;4(6):1179-87. doi: 10.2147/vhrm.s3096.
Subjects with peripheral arterial disease (PAD) of the lower limbs are at high risk for cardiovascular and cerebrovascular events and the prevalence of coronary artery disease in such patients is elevated. Recent studies have shown that regular use of cardiovascular medications, such as therapeutic and preventive agents for PAD patients, seems to be promising in reducing long-term mortality and morbidity. The angiotensin-converting-enzyme (ACE) system plays an important role in the pathogenesis and progression of atherosclerosis, and ACE-inhibitors (ACE-I) seem to have vasculoprotective and antiproliferative effects as well as a direct anti-atherogenic effect. ACE-I also promote the degradation of bradykinin and the release of nitric oxide, a potent vasodilator; further, they have shown important implications for vascular oxidative stress. Other studies have suggested that ACE-I may also improve endothelial dysfunction. ACE-I are useful for reducing the risk of cardiovascular events in clinical and subclinical PAD. Particularly, one agent of the class (ie, ramipril) has shown in many studies to able to significantly reduce cardiovascular morbidity and mortality in patients with PAD.
下肢外周动脉疾病（PAD）患者发生心血管和脑血管事件的风险很高，此类患者中冠状动脉疾病的患病率也有所升高。最近的研究表明，定期使用心血管药物，如用于PAD患者的治疗和预防药物，在降低长期死亡率和发病率方面似乎很有前景。血管紧张素转换酶（ACE）系统在动脉粥样硬化的发病机制和进展中起重要作用，而ACE抑制剂（ACE-I）似乎具有血管保护和抗增殖作用以及直接的抗动脉粥样硬化作用。ACE-I还能促进缓激肽的降解和一氧化氮（一种强效血管扩张剂）的释放；此外，它们对血管氧化应激也有重要影响。其他研究表明，ACE-I也可能改善内皮功能障碍。ACE-I有助于降低临床和亚临床PAD患者发生心血管事件的风险。特别是，该类药物中的一种（即雷米普利）在许多研究中已显示能够显著降低PAD患者的心血管发病率和死亡率。
