The current role of ACE-inhibitors for secondary prevention in cardiovascular disease; from pathogenesis to clinical practice.

摘要

The most important questions in cardiovascular medicine remains the pathogenesis of atherosclerosis. The role of the endothelium in modulating the atherosclerotic process gained interest in the early nineties, and resulted in a major step ahead in our understanding of the atherosclerotic process. At that time, it became clear that activation of the local renin-angiotensin system played an important role in promoting atherosclerosis and plaque rupture. It was postulated that the local renin-angiotensin system was activated by the classical risk factors, such as smoking, hypertension (shear stress) and lipids. Several animal experimental studies demonstrated anti-atherosclerotic properties of ACE-inhibitors. A few years later, the first clinical studies all demonstrated that ACE-inhibitors reduced the incidence of cardiovascular events.