Potential role of angiotensin-converting enzyme inhibition in myocardial ischemia and current clinical trials.

The understanding of the atherosclerotic disease process has broadened during the past few years to include the roles of the endothelium and of tissue angiotensin-converting enzyme (ACE) as regulators of a complex interaction of events that may lead to the development of atherosclerosis and, eventually, to the occurrence of clinical ischemia-related events. Several large clinical trials using ACE inhibitors have previously demonstrated a reduced risk of morbidity and mortality in patients with coronary artery disease and left ventricular dysfunction and in patients with heart failure or who had experienced an acute myocardial infarction. The effects of ACE inhibition are now being evaluated in other ongoing or recently completed trials in patients with evidence of coronary artery disease, but who have preserved left ventricular function and do not have an acute infarction. The results of these trials can be expected to enhance further our ability to intervene in the atherosclerotic process, resulting in improved outcomes in patients with coronary artery disease.