Heather L. Horton, MD, PhD
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Horton H.; Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction. Ann Intern Med. 2005;142:78. doi: 10.7326/0003-4819-142-1-200501040-00019
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Published: Ann Intern Med. 2005;142(1):78.
TO THE EDITOR:
Although a difference in effect of ACE inhibitors cannot be excluded, the improved survival reported by Pilote and colleagues (1) with ramipril compared with other agents might be alternatively explained by the higher rates of statin and β-blocker use in the ramipril group. The accompanying editorial (2) noted these higher rates, although not as a possible cause of Pilote and colleagues' results.
According to Pilote and colleagues' data, ACE inhibitors with best to worst survival rates were ramipril, perindopril, lisinopril, enalapril, quinapril, fosinopril, and captopril. Statin use in these groups was 39.2%, 37%, 30.5%, 21.4%, 26.9%, and 14.7%, respectively, and β-blocker use was 70.8%, 70%, 56.7%, 52.6%, 55.4%, 54.3%, and 45.6%, respectively. Given that both statins and β-blockers improve survival after myocardial infarction, it is likely that the differences in survival, which relatively paralleled the differences in both β-blocker and statin use, were due not to differences in the ACE inhibitors but to the concomitant medical therapy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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