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Coronary heart disease secondary prevention renin-angiotensin-aldosterone system blockers

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]

ACE Inhibitors (DO NOT EDIT) [1]

Class I
“1. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction]] ≤40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. [2][3] (Level of Evidence: A)”
Class IIa
“1. It is reasonable to use ACE inhibitors in all other patients. [4] (Level of Evidence: B)

ARBs (DO NOT EDIT) [1]

Class I
“1. The use of ARBs is recommended in patients who have heart failure or who have had a myocardial infarction with left ventricular ejection fraction ≤40% and who are ACE-inhibitor intolerant. [5][6][7] (Level of Evidence: A)”
Class IIa
“1. It is reasonable to use ARBs in other patients who are ACE-inhibitor intolerant. [8] (Level of Evidence: B)
Class IIb
“1. The use of ARBs in combination with an ACE inhibitor is not well established in those with systolic heart failure. [7][9] (Level of Evidence: A)

Aldosterone Blockade (DO NOT EDIT) [1]

Class I
“1. Use of aldosterone blockade in post–myocardial infarction patients without significant renal dysfunction# or hyperkalemia** is recommended in patients who are already receiving therapeutic doses of an ACE inhibitor and β-blocker, who have a left ventricular ejection fraction ≤40%, and who have either diabetes or heart failure. [10][11] (Level of Evidence: A)”
“ # Estimated creatinine clearance should be >30 mL/min. ”
“ ** Potassium should be <5.0 mEq/L. ”

References

  1. ↑ 1.0 1.1 1.2 1.3 Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). “AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation”. Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.
  2. ↑ Garg R, Yusuf S (1995). “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. 273 (18): 1450–6. PMID 7654275. Unknown parameter |month= ignored (help)
  3. ↑ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000). “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. 342 (3): 145–53. doi:10.1056/NEJM200001203420301. PMID 10639539. Unknown parameter |month= ignored (help)
  4. ↑ Fox KM (2003). “Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)”. Lancet. 362 (9386): 782–8. PMID 13678872. Unknown parameter |month= ignored (help)
  5. ↑ Pitt B, Poole-Wilson PA, Segal R; et al. (2000). “Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial–the Losartan Heart Failure Survival Study ELITE II”. Lancet. 355 (9215): 1582–7. PMID 10821361. Unknown parameter |month= ignored (help)
  6. ↑ Pfeffer MA, Swedberg K, Granger CB; et al. (2003). “Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme”. Lancet. 362 (9386): 759–66. PMID 13678868. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Pfeffer MA, McMurray JJ, Velazquez EJ; et al. (2003). “Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both”. N. Engl. J. Med. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMID 14610160. Unknown parameter |month= ignored (help)
  8. ↑ Yusuf S, Teo K, Anderson C; et al. (2008). “Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial”. Lancet. 372 (9644): 1174–83. doi:10.1016/S0140-6736(08)61242-8. PMID 18757085. Unknown parameter |month= ignored (help)
  9. ↑ Yusuf S, Teo KK, Pogue J; et al. (2008). “Telmisartan, ramipril, or both in patients at high risk for vascular events”. N. Engl. J. Med. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. PMID 18378520. Unknown parameter |month= ignored (help)
  10. ↑ Pitt B, Remme W, Zannad F; et al. (2003). “Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction”. N. Engl. J. Med. 348 (14): 1309–21. doi:10.1056/NEJMoa030207. PMID 12668699. Unknown parameter |month= ignored (help)
  11. ↑ Zannad F, McMurray JJ, Krum H; et al. (2011). “Eplerenone in patients with systolic heart failure and mild symptoms”. N. Engl. J. Med. 364 (1): 11–21. doi:10.1056/NEJMoa1009492. PMID 21073363. Unknown parameter |month= ignored (help)


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