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Summary and Discussion

A succinct summary of evidence on comparative long-term benefits and harms of ACE inhibitors and/or ARBs in patients with preserved left ventricular function who have stable ischemic heart disease or heart disease risk equivalents is presented in Table 15. More elaborate discussions are provided at the end of the results for each Key Question. More detailed assessments of strength of evidence for major clinical outcomes and harms are summarized in a EPC grading table of evidence (Appendix Tables 41–). Major clinical outcomes are those explicitly stated in Key Questions 1–3 and 7 and harms in Key Questions 4–6. Members of the TEP identified these outcomes as important because they are most relevant to patients, clinicians, and policymakers; and have adequate data from studies meeting eligibility criteria for the comparative effectiveness review. Clinical outcomes included total mortality, cardiovascular mortality, nonfatal myocardial infarction, stroke, a composite of cardiovascular mortality, nonfatal myocardial infarction and stroke, atrial fibrillation, symptom reporting, total hospitalizations, hospitalization for angina, hospitalization for heart failure, revascularization and quality of life. Harms included withdrawals due to adverse events, hypotension, syncope, cough, angioedema, hyperkalemia, rash, and blood dyscrasias.


A summary of the search results for the primary literature review is presented in Figures 3 and .

Executive Summary

Nearly 2,400 Americans die of cardiovascular disease each day, an average of one death every 36 seconds. Cardiovascular disease claims more lives each year than cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus combined. An estimated 79,400,000 American adults (one in three), of whom 37,500,000 are estimated to be age 65 or older, have one or more types of cardiovascular disease. Approximately 8,900,000 adults suffer from angina. Since 1900, cardiovascular disease has accounted for more deaths than any other single cause or group of causes of death in the United States in every year except one.


This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) concerning the benefits and harms associated with using angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), either alone or in combination, in people with stable ischemic heart disease or ischemic heart disease risk equivalents and intact left ventricular systolic function.

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