[Angiotensin converting enzyme inhibitors and ischemic heart diseases].

Experimental studies and molecular biological techniques have demonstrated the importance of angiotensin II in ventricular and vascular remodelling and in atherogenesis. Large scale clinical trials analysing the effects of converting enzyme inhibitors on the mortality and morbidity in post-infarction left ventricular dysfunction, have shown beneficial effects of these agents on major events of coronary artery disease. Experimental studies have shown reduction of intimal thickening and of the multiplication and migration of smooth muscle cells and of vascular fibrosis. Converting enzyme inhibitors seem to restore endothelial function by acting as donors of NO and could play a role in the stabilisation of atheromatous plaque, the prevention of platelet aggregation and on the activation of intravascular fibrinolytic systems. Large scale clinical trials (SOLVD and the prevention and treatment arms of SAVE) have also shown a 23% reduction in the risk of reinfarction and a 15% reduction in the risk of unstable angina. The results of ongoing trials in patients with coronary artery disease without cardiac failure are awaited with great impatience.