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Clinician Guide – Jul. 9, 2010
AHRQ released a new consumer and clinician summary guides on coronary heart disease. The clinician guide, Adding ACEIs and/or ARBs to Standard Therapy for Stable Ischemic Heart Disease: Benefits and Harms offers clinical bottom line findings. The findings include level-of-confidence ratings for possible benefits and harms. The consumer guide, “ACE Inhibitors” and “ARBs” To Protect Your Heart?, provides plain-language information on coronary heart disease and helps patients work with clinicians to understand the benefits and risks of these treatments.

Adding ACEIs and/or ARBs to Standard Therapy for Stable Ischemic Heart Disease: Benefits and Harms

Clinician Guide (PDF) 306 kB
http://www.effectivehealthcare.ahrq.gov/ehc/products/57/385/ischemicheart_clinician_web.pdf

Table of Contents
•Key Clinical Issue
•Background Information
•Clinical Bottom Line
•Outcomes Table
•Note Regarding Possible Harms
•Gaps in Knowledge
•What To Discuss With Your Patients
•Resources for Patients
•Source
•Ordering Information

Key Clinical Issue
Should standard medical therapy in patients with stable ischemic heart disease be augmented with an ACEI (angiotensin-converting enzyme inhibitor) or an ARB (angiotensin II receptor blocker)?

Background Information
Patients who have chronic stable angina, or stable ischemic heart disease (IHD) with preserved left ventricular systolic function (LVSF), can remain symptomatic and at risk for fatal and nonfatal cardiovascular events, even though they may be optimally treated with standard medical therapy or revascularization.

•Standard medical treatement may include aspirin, statins, β-blockers, dual antiplatelet therapy, or combinations of these agents. Nitrates and calcium channel blockers may also be used to achieve symptomatic relief.
•Revascularization procedures can include balloon angioplasty with or without stenting to open up the affected vessels of the heart or coronary artery bypass grafting that attempts to bypass a diseased vessel.


ACEIs and ARBs have been shown to reduce morbidity and mortality in patients with left ventricular systolic dysfunction (LVSD) in the settings of chronic heart failure and myocardial infarction and also in patients with diabetes mellitus that is accompanied by proteinuria or chronic kidney disease.

This summary does not discuss ACEI or ARB therapy for patients with currently accepted indications for these drugs, including LVSD, evidence or diagnosis of heart failure, or a diagnosis of cardiomyopathy. This summary presents the benefits and risks of supplementing standard medical therapy with ACEIs or ARBs to patients with stable IHD and preserved LVSF. It is based on a systematic review of the research conducted for this population, which included 12 trials (n=41,672).

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