Vol.6, No 1, 1999 pp. 69 - 72
UC 616.074
LONG-TERM EFFECT OF CAPTOPRIL ON PLASMA
LIPIDS IN ACUTE MYOCARDIAL INFARCTION: POSSIBLE MECHANISM OF ANTIATHEROSCLEROTICAL
EFFECT OF ACE INHIBITION
Zorana Vasiljević1, Aneta Bošković1, Miodrag
Ostojić1, Milica Prostran2, Nikola Kocev3
1Institute for Cardiovascular Diseases, Belgrade, Yugoslavia
2Department of Clinical Pharmacology, Pharmacology and Toxicology,
School of Medicine, Belgrade, Yugoslavia
3Institute for Medical Statistics, Belgrade, Yugoslavia
Summary. It is known that ACE inhibitors have beneficial effects
on the left ventricular function and cardiovascular events after myocardial
infarction. Also, it is important that ACE inhibitors are lipid neutral,
with no deleterious effects on the lipid status. The lipid status could
influence progression of atherosclerosis and coronary artery related events.
There is no reported long-term clinical study of ACE inhibitor treatment
in and after acute myocardial infarction on a lipid status.
In the placebo-controlled open label randomized study, 104 patients
with acute myocardial infarction were observed for a period of seven years:
52 patients with standard therapy (con group) and 52 patients with captopril
therapy (cap group), 6.25 mg the first 12 h after the onset of AMI, followed
by 6.25 mg to 25 mg two times daily. No differences were observed between
the groups at baseline. The seven years period was reached by 80 patients;
in the captopril group, there were less patients with cardiovascular events
(p<0.05), less patients with clinical signs of heart failure, less mortality,
and higher levels (p<0.02) of HDL cholesterol.
Despite the small group of patients (n=52), statistically significant
increase in HDL cholesterol values and less pronounced mortality and morbidity
during the entire period of seven years were observed in the cap group.
Key words: Captopril, lipids, myocardial infarction
DUGOTRAJNO DEJSTVO KAPTOPRILA NA LIPIDE
PLAZME U AKUTNOM INFARKTU MIOKARDA: MOGUĆI MEHANIZAM DEJSTVA ACE INHIBITORA
U PREVENCIJI ATEROSKLEROZE
Kratak sadržaj: Poznato je da ACE inhibitori imaju povoljno dejstvo
na funkciju leve komore i kardiovaskularne dogadjaje posle infarkta miokarda.
Prema kliničkim iskustvima inhibitori ne ispoljavaju negativno dejstvo
na lipidni status ("neutralni"), koji utiče na progresiju ateroskleroze
i koronarnu bolest. Za sada, nema rezultata dugotrajnih kliničkih studija
o uticaju ACE inhibitora na lipidni status bolesnika posle akutnog infarkta
miokarda.
U ovoj otvorenoj randomiziranoj kontrolisanoj kliničkoj studiji uz
primenu placeba, učestvovalo je 104 bolesnika sa akutnim infarktom miokarda,
koji su praćeni 7 godina. U kontrolnoj grupi (n=52) primenjivana je standardna
farmakoterapija, dok je druga grupa (n=52) primala i kaptopril 6,25 mg
12 sati posle akutnog infarkta miokarda, a zatim od 6,25 mg do 25 mg, dva
puta na dan, sve do kraja studije.
Sedmogodišnji period je preživelo 80 bolesnika. U grupi lečenih kaptoprilom
bilo je manje bolesnika sa kardiovaskularnim neželjenim ishodom (p<0,05),
kao i manje bolesnika sa kliničkim znacima srčane insuficijencije. Osim
toga, u grupi lečenoj kaptoprilom, zapažen je povisen nivo HDL holesterola
i manji mortalitet nego u kontrolnoj grupi.
Ključne reči: Kaptopril, lipidi, infarkt miokarda
