Comparison of the effect of enalapril and losartan in conjunction with surgical coronary revascularisation versus revascularisation alone on systemic endothelial function. Issue 8 (14th July 2005)

• Record Type: Journal Article
• Authors: Trevelyan, J; Needham, E W A; Morris, A; Mattu, R K
• Is Part Of: Heart. Volume 91:Issue 8(2005)
• Page Start: 1053
• Page End: 1057
• Publication Date: 2005-07-14
• Subjects: ACE, angiotensin converting enzyme -- AT1, angiotensin II type 1 receptor -- CABG, coronary artery bypass grafting -- D, deletion -- FMD, flow mediated dilatation -- I, insertion; ACE genotype -- ACE inhibitors -- coronary bypass surgery -- endothelial function; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2004.036897
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To investigate the effect of enalapril, losartan, and surgical coronary revascularisation on endothelial function, and the role of the angiotensin converting enzyme (ACE) insertion (I)/deletion (D) polymorphism. Design: Randomised, controlled, blinded end point study. Setting: University tertiary referral cardiac centre. Patients and interventions: 49 men awaiting coronary artery bypass grafting (CABG) were randomly assigned to treatment with losartan, enalapril, or control for two months before and three months after surgery. Main outcome measures: Endothelial function was blindly analysed by brachial artery flow mediated dilatation (FMD) and ACE I/D genotype was determined. Results: FMD was impaired at baseline (1.0–1.7%) and after five months had improved to 5.2% with enalapril (p = 0.015), 5.0% with losartan (p = 0.0004), and 3.0% with CABG alone (p = 0.05). Patients with the II genotype had lower baseline FMD than those with DI or DD (0.1% v 1.7%, p = 0.038) and after enalapril or losartan treatment had greater improvement in FMD (mean (SEM) 7.1 (1.1)%) than patients with DI (3.1 (1.3)%, p = 0.024) or DD genotype (3.1 (1.1)%, p = 0.02). Conclusions: Enalapril and losartan, with surgical coronary revascularisation, significantly improve systemic endothelial function. Revascularisation alone produces a quantitatively smaller, but still significant, improvement. The ACE genotype significantly modulates this response. Patients with the II genotype have a more pronounced impairment in endothelial function at baseline and a greater improvement in response to treatment with these agents.