An international trial suggests that many of the people who take angiotensin-converting enzyme (ACE) inhibitors may not need the drugs.

What the researchers wanted to know: In people with stable coronary artery disease, do ACE inhibitors add anything to the conventional therapy?

What they did: Nearly 8,300 patients at 187 sites in the United States, Canada, and Italy joined the trial. They all had stable coronary artery disease, meaning they'd had a heart attack, bypass surgery, or angioplasty, or they had at least one coronary blood vessel more than half obstructed. Their left ventricles, the part of the heart that sends blood to the rest of your body, were normal or nearly normal. None had a condition that would require an ACE inhibitor, and none were already taking the drugs. Most were taking cholesterol-lowering drugs. They were randomly assigned to take either the ACE inhibitor trandolapril (Mavik) or a placebo and came in for a follow-up appointment and more pills every six months for up to seven years. Some of the placebo patients were prescribed an ACE inhibitor during the trial.

What they found: The ACE inhibitor did not help. People on the drug were just as likely as people on the placebo to experience the endpoints that the researchers were looking for—for example, the primary endpoint, defined as dying from cardiovascular causes, nonfatal heart attacks, or needing a procedure to improve blood flow to the heart. The ACE inhibitor did reduce blood pressure. In other studies, ACE inhibitors have looked very promising for people like these. But the researchers say the patients in this trial were probably a bit healthier to start with—even people on placebo did better in this trial than people on placebo did in the earlier trials. The fact that 70 percent were on cholesterol-lowering drugs probably helped.

What the study means to you: If your heart and blood vessels are in similar condition to those of the patients who entered this trial and you're already having good heart care, ACE inhibitors may not be necessary.

Caveats: This is only one ACE inhibitor; others might be more effective.

Find out more: Information from the National Library of Medicine on trandolapril

Read the article: The PEACE Trial Investigators. "Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease." New England Journal of Medicine. Nov. 11, 2004, Vol. 351, No. 20, pp. 2058–2068.

Abstract online: http://content.nejm.org