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[IP] Aspirin and ACE Inhibitors

I Found this regarding the above continuing dicussion
Aspirin and ACE Inhibitors
Howard C. Herrmann, MD Editor

Because research findings presented at scientific
meetings are preliminary, as I explained in my
editors letter, we typically wait until theyre
published to write extensively about them. But many of
my patients have expressed concern over what theyve
heard in the news about one particular study from the
recent American College of Cardiology (ACC) meeting,
so Id like to address it. This presentation concerned
a possibly dangerous drug interaction.

Most new medications are first studied in carefully
controlled circumstances and in patients with only a
few medical problems. However, when the drugs are made
widely available and prescribed to sicker people who
are also taking several other medications, drug
interactions may become apparent. This may be a
problem in patients taking two commonly used heart
drugs, aspirin and angiotensin converting enzyme (ACE)
inhibitors (such as captopril, enalapril, and
lisinopril). Many people with coronary artery disease
take aspirin to cut their risk for a heart attack. And
many people who also have congestive heart failure
also take ACE inhibitors, which boost survival. In the
recent ACC presentation, scientists looked back at a
previous angioplasty study in which all the
participants were taking aspirin. The researchers
found that the people who also happened to be taking
ACE inhibitors were more than twice as likely to die
within one year. But its not that simple, because the
sickest participants were also the people most likely
to be prescribed both drugs. They tended to be older
than the other participants, more likely to already
have had a heart attack, and more likely to have
diabetes and high blood pressure. In these people, the
left ventricle (the hearts main pumping chamber) was
also weaker. So when the researchers looked at the
death rate in the group of people taking both drugs,
these sickest people were overrepresented. This may
have inflated the death rate, though the researchers
tried to account for that effect statistically. Also,
its not clear exactly how aspirin and ACE inhibitors
might interfere with each other, though it may involve
the drugs opposite actions on hormones called

There are newer alternatives to aspirin and ACE
inhibitors, many of which dont affect prostaglandin
function. But these agents arent as well studied as
the older drugs, and they may not prove as helpful to
heart patients.

For now, I recommend not stopping your current aspirin
regimen or ACE inhibitor. Because the people on both
drugs were sicker to begin with, the possibility
remains that this, and not a drug interaction, is the
true reason for the higher death rate. Future,
better-designed studies should answer this question.
Until the results of these studies are in, Im not
taking my patients off of these proven lifesavers. We
at Heart Watch will continue to keep you posted on any
new developments in this area. 

Minimed 508 - DX 1972 - Pumping Since 5/30/2000

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