Long term ACE-inhibition in patients after CABG reduces levels of soluble ICAM-1

Chapter 4 50 The present study aimed to examine the effects of long-term treatment with the angiotensin-converting-enzyme-inhibitor quinapril on markers of inflammation in patients requiring coronary artery bypass grafting. We performed a subgroup analysis of a prospective, placebo-controlled , randomized, multi-center study evaluating quinapril 40 mg. once daily in patients scheduled to undergo elective coronary artery bypass grafting. Levels of s-ICAM and C-reactive protein were measured at baseline (≥4 weeks before surgery) and 1 year after coronary artery bypass grafting. A total of 87 subjects were studied; 42 subjects used quinapril (q) and 45 subjects obtained a placebo (p). There was no difference in baseline levels of s-ICAM between both groups (142.2 µg/L vs. 136.6 µg/L). We found a significant reduction in levels of s-ICAM-1 in patients using quinapril (142.2 ± 10.8 µg/L vs. 125.6 ± 9.4 µg/L, P <0.05), whereas no differences were found in the placebo group (136.6 ± 10.2 µg/L vs. 131.2 ± 11.7 µg/L, P =n.s.). Levels of C-reactive protein remained unchanged in both groups (3.70 ± 0.85 vs. 2.73 ± 0.32 mg/L (q), 2.85 ± 0.48 vs. 3.16 ± 0.50 mg/L (p)). We conclude that treatment with quinapril reduces levels of soluble ICAM in patients with established coronary artery disease requiring coronary artery bypass grafting. These results suggest that the beneficial effects of angiotensin-converting-enzyme-inhibitors in the treatment of cardio-vascular disease may partly be due to a reduction of the vascular inflammatory response.