Early clinical studies investigating the role of angiotensin-converting enzyme (ACE) inhibitors in the\ud treatment of heart failure unexpectedly demonstrated a possible reduction in coronary heart disease\ud endpoints. Two large scale clinical trials, HOPE and EUROPA, both studies in patients with coronary\ud artery disease (CAD) but without clinical evidence of heart failure, showed a highly significant improvement\ud in coronary heart disease outcomes on treatment with ramipril and perindopril, respectively, in\ud contrast, in a similar population, PEACE was unable to demonstrate such benefit with trandolapril.\ud Meta-analyses of all trials involving ACE-inhibitors showed a highly significant improvement in coronary\ud heart disease endpoints. Current ESC guidelines recommend ACE-inhibitor therapy in CAD patients with\ud co-existing indications for ACE-inhibitors, such as hypertension, heart failure, left ventricular dysfunction,\ud prior MI was left ventricular dysfunction, or diabetes (class I, level of evidence A). These guidelines\ud also recommend ACE-inhibitor therapy in all patients with angina and proven coronary disease (class IIa,\ud level of evidence B). However, in angina patients without independent indication for ACE-inhibitor\ud treatment, the anticipated benefit should be weighted against the costs and risks of side effects; in\ud these patients, only agents and doses of proven efficacy for secondary prevention should be employed
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