Is Improved Survival a Class Effect of Angiotensin-Converting Enzyme Inhibitors?
Authors: Sean Hennessy, Stephen E. Kimmel
Journal: Annals of Internal Medicine (2004)

Editorials20 July 2004Is Improved Survival a Class Effect of Angiotensin-Converting Enzyme Inhibitors?Sean Hennessy, PharmD, PhD and Stephen E. Kimmel, MD, MSCESean Hennessy, PharmD, PhDFrom University of Pennsylvania School of Medicine, Philadelphia, PA 19106.Search for more papers by this author and Stephen E. Kimmel, MD, MSCEFrom University of Pennsylvania School of Medicine, Philadelphia, PA 19106.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-2-200407200-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Randomized trials have shown that several but not all angiotensin-converting enzyme (ACE) inhibitors, when given at specific doses, increase survival in specific populations of patients with heart disease. Whether improved survival is a “class effect” of ACE inhibitors is a question of considerable clinical interest, and one that motivated the study by Pilote and colleagues in this issue (1). Clearly the answer to this question is not yet known, since the requisite head-to-head randomized trials have not been done. Unfortunately, such trials are not likely to be imminent because of the enormous size and expense of comparative trials of survival ...References1. Pilote L, Abrahamowicz M, Rodrigues E, Eisenberg MJ, Rahme E. Mortality rates in elderly patients who take different angiotensin-converting enzyme inhibitors after acute myocardial infarction: a class effect? Ann Intern Med. 2004;141:102-12. LinkGoogle Scholar2. McAlister FA, Laupacis A, Wells GA, Sackett DL. Users' Guides to the Medical Literature: XIX. Applying clinical trial results B. Guidelines for determining whether a drug is exerting (more than) a class effect. JAMA. 1999;282:1371-7. [PMID: 10527185] CrossrefMedlineGoogle Scholar3. Varela MP, Lew SQ, Smith AM, Whyte RL, Bosch JP. Outcome of an opportunistic infection after polymicrobial peritonitis in an HIV-infected patient treated with peritoneal dialysis. Am J Nephrol. 1999;19:682-5. [PMID: 10592364] CrossrefMedlineGoogle Scholar4. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA. 1995;273:1450-6. [PMID: 7654275] CrossrefMedlineGoogle Scholar5. Strom BL. The use of pharmacoepidemiology to study beneficial drug effects.. In: Strom BL, eds. Pharmacoepidemiology. 3rd ed. Chichester, United Kingdom: J Wiley; 2000. Google Scholar6. Strom BL, Miettinen OS, Melmon KL. Postmarketing studies of drug efficacy: when must they be randomized? Clin Pharmacol Ther. 1983;34:1-7. [PMID: 6861430] CrossrefMedlineGoogle Scholar7. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993;342:821-8. [PMID: 8104270] MedlineGoogle Scholar8. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145-53. [PMID: 10639539] CrossrefMedlineGoogle Scholar9. Sica DA. The Heart Outcomes Prevention Evaluation study: angiotensin-converting enzyme inhibitors: are their benefits a class effect or do individual agents differ? [Editorial]. Curr Opin Nephrol Hypertens. 2001;10:597-601. [PMID: 11496052] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sean Hennessy, PharmD, PhD; Stephen E. Kimmel, MD, MSCEAffiliations: From University of Pennsylvania School of Medicine, Philadelphia, PA 19106.Disclosures:Consultancies: S. Hennessy (consulting for a law firm representing Novartis in a matter unrelated to ACE inhibitors), S.E. Kimmel (consulting for Parke-Davis and Pfizer in matters unrelated to ACE inhibitors); Grants received: S. Hennessy (Pfizer [unrelated to ACE inhibitors]), S.E. Kimmel (Merck, Novartis, and Pfizer [unrelated to ACE inhibitors]).Corresponding Author: Sean Hennessy, PharmD, PhD, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 803 Blockley Hall, Philadelphia, PA 19104-6021; e-mail, [email protected]med.upenn.edu.Current Author Addresses: Dr. Hennessy: Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 803 Blockley Hall, Philadelphia, PA 19104-6021.Dr. Kimmel: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 717 Blockley Hall, Philadelphia, PA 19104-6021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMortality Rates in Elderly Patients Who Take Different Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction: A Class Effect? Louise Pilote , Michal Abrahamowicz , Eric Rodrigues , Mark J. Eisenberg , and Elham Rahme Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction Ulrich Jorde Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction Heather L. Horton Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction Louise Pilote and Michal Abrahamowicz Metrics Cited byTime until incident dementia among Medicare beneficiaries using centrally acting or non-centrally acting ACE inhibitorsThe Role of Renin Angiotensin System Intervention in Stage B Heart FailureWhen Should We Believe Nonrandomized Studies of Comparative Effectiveness?Angiotensin-Converting Enzyme Inhibitors in Acute Myocardial Infarction: A Clinical ApproachThe Class Effect Is Relevant to GeriatricsAngiotensin-Converting Enzyme Inhibitors after Acute Myocardial InfarctionUlrich Jorde, MDAngiotensin-Converting Enzyme Inhibitors after Acute Myocardial InfarctionHeather L. Horton, MD, PhDAngiotensin-Converting Enzyme Inhibitors after Acute Myocardial InfarctionLouise Pilote, MD, MPH, PhD and Michal Abrahamowicz, PhD 20 July 2004Volume 141, Issue 2Page: 157-158KeywordsACE inhibitorsClinical epidemiologyClinical trialsCongestive heart failureDrugsMortalityMyocardial infarctionPilot studiesRandomized trialsRelative risk ePublished: 20 July 2004 Issue Published: 20 July 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...