Ulrich Jorde, MD
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Jorde U.; Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction. Ann Intern Med. 2005;142:78. doi: 10.7326/0003-4819-142-1-200501040-00018
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Published: Ann Intern Med. 2005;142(1):78.
TO THE EDITOR:
Pilote and colleagues (1) presented data suggesting that ramipril was superior to other angiotensin-converting enzyme (ACE) inhibitors after myocardial infarction. Their carefully discussed methods, in concert with the accompanying outstanding editorial (2), should confer the overall message that the study's design and limitations render its findings no more than hypothesis-generating. The authors rightfully pointed out that the distribution of observed mortality differences among the 7 ACE inhibitors studied is not consistent with any known pharmacologic property of these agents (that is, ACE inhibitors with higher tissue affinity did not consistently fare better than those with low tissue affinity). In addition, the editorial noted that mortality differences among ACE inhibitors in Pilote and colleagues' analysis were larger than those between ACE inhibitors and placebo in randomized trials (raising significant concerns about the validity of their data). In addition, β-blocker and statin use was substantially higher in patients receiving ramipril. Therefore, the conclusion that “survival benefits … seem to differ according to the specific ACE inhibitor prescribed” seems somewhat premature, much like the similar content of the take-home message in the Summary for Patients (3).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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