Avtor/Urednik		Šabovič, Mišo
Naslov		Pomen zaviralcev angiotenzinske konvertaze pri zdravljenju ishemične bolezni srca
Prevedeni naslov		The role of ACE inhibitors in the treatment of coronary artery disease
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 46, št. Suppl 1
Leto izdaje		2007
Obseg		str. 123-8
Jezik		slo
Abstrakt		Inhibitors of angiotensin converting enzyme (ACE inhibitors) are well established in the treatment of arterial hypertension, heart failure and postinfarction dysfunction of the left ventricle. There is growing evidence that the renin-angiotensin system also has an important role in the pathogenesis of atherosclerosis and coronary artery disease. Angiotensin II increases oxidative stress and consequent production of free radicals in the arterial wall. It is becoming evident that increased oxidative stress is one of the most important processes in atherosclerosis. Free radicals induce and facilitate endothelial dysfunction, inflammation in the arterial wall and oxidation of LDL cholesterol. Inhibition of angiotensin II decreases its proatherogenic effects. In large clinical trials (HOPE, EUROPA), ACE inhibitors (ramipril, perindopril) were found effective in the prevention of myocardial infarction and stroke, even in patients taking aspirin, statins and beta blockers. This beneficial effect is beyond pressure lowering. Overall, it is clear that treatment with ACE inhibitors is beneficial in patients with manifest atherosclerosis or high risk for it.
Izvleček		Zaviralci angiotenzinske konvertaze (ACE) so uveljavljeni v zdravljenju arterijske hipertenzije, srčnega popuščanja in poinfarktne disfunkcije levega prekata. V zadnjih letih se kopičijo dokazi o pomembnosti vloge renin-angiotenzinskega sistema oziroma angiotenzina II v procesu ateroskleroze in ishemične bolezni srca. Ugotovljeno je, da je angiotenzin II pomemben aktivator oksidativnega stresa v arterijski steni in posledično zvečanega nastanka prostih radikalov. Prosti radikali okvarjajo endotelijsko funkcijo, pospešijo vnetje v žilni steni in oksidirajo LDL-holesterol. Oviranje angiotenzina II, ki se nahaja v arterijski steni, ima zato zaščitne učinke pri ishemični bolezni srca. V kliničnih raziskavah (HOPE, EUROPA) so ugotovili, da zdravljenje z zaviralci ACE (ramipril, perindopril) zmanjša pojavnost srčnega infarkta in tudi možganske kapi. Pomembno je poudariti, da ta ugotovitev velja za bolnike, ki jemljejo aspirin, statine in blokatorje beta in da je učinek zaviralcev ACE neodvisen od njihovega učinka na arterijski tlak. Zdravljenje z zaviralci ACE koristi vsem bolnikom z manifestno ishemično boleznijo srca ali velikim tveganjem za razvoj le-te.
Deskriptorji		CORONARY DISEASE ANGIOTENSIN-CONVERTING ENZYME INHIBITORS