Related Drugs Vary in Benefit After Heart Attack

Drugs called ACE inhibitors have been shown to improve survival after a heart attack, but new research suggests that some ACE inhibitors, namely ramipril and perindopril, work better than others.

Drugs called ACE inhibitors have been shown to improve survival after a heart attack, but new research suggests that some ACE inhibitors, namely ramipril and perindopril, work better than others. ACE inhibitors vary in potency and in how they are metabolized by the body, factors that could influence their effectiveness, Dr. Louise Pilote, from Montreal General Hospital, and associates point out in the Annals of Internal Medicine. To compare the benefits of various ACE inhibitors, the researchers analyzed data from 7512 patients who took a single ACE inhibitor for at least 1 year after a heart attack. Patients treated with ramipril or perindopril had nearly the same risk of death, which was 28 to 71 percent lower than the risk seen in patients treated with other ACE inhibitors. Moreover, the advantage for ramipril and perindopril persisted for up to 5 years after the heart attack. “Our results suggest that not all drugs within the class of ACE inhibitors should be considered to have the same effect,” the researchers conclude. Forward-looking studies with direct comparisons between different ACE inhibitors may be warranted, they add. However, these findings may be subject to bias, Drs. Sean Hennessy and Stephen E. Kimmel, from the University of Pennsylvania in Philadelphia, maintain in a related editorial. For example, patients prescribed ramipril and perindopril were more likely to be using other potentially beneficial drugs, suggesting that they may simply have received better medical care than their peers. (SOURCE: Annals of Internal Medicine: Reuters Health News: July 2004.)