UNSPECIFIED. (2005) Comparison of the effect of enalapril and losartan in conjunction with surgical coronary revascularisation versus revascularisation alone on systemic endothelial function. HEART, 91 (8). pp. 1053-1057. ISSN 1355-6037

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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.

Item Type:	Journal Article
Subjects:	Q Science > QM Human anatomy
Journal or Publication Title:	HEART
Publisher:	B M J PUBLISHING GROUP
ISSN:	1355-6037
Date:	August 2005
Volume:	91
Number:	8
Number of Pages:	5
Page Range:	pp. 1053-1057
Identification Number:	10.1136/hrt.2004.036897
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/6814

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