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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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Management of the Patient with Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

Case Summary:

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II-receptor blockers (ARBs) are proven therapies that reduce morbidity and mortality in patients with left ventricular systolic dysfunction (LVSD) with chronic heart failure, and have also shown to reduce the progression of nephropathy in patients with diabetes mellitus and proteinuria. It is less clear how ACEIs contribute to the reduction of cardiovascular events in patients with stable IHD who also have preserved left ventricular systolic function (LVSF), as determined by a left ventricular ejection fraction (LVEF) >40%. These patients have relatively intact LVSF, yet may present with chest pain (angina pectoris) brought on by emotional or physical stress. These symptoms are usually due to one or more clogged or diseased arteries that result in reduced blood flow and oxygen supply to the heart. Therapies shown to reduce the risk for cardiovascular events in IHD patients include aspirin, statins, beta-blockers, and dual anti-platelet therapy. Other agents used for symptomatic relief include nitrates and calcium channel blockers (CCB). A revascularization procedure to circumvent or treat a blocked vessel is another therapeutic option for patients unresponsive or intolerant to these medications. A patient will need prolonged treatment with these medications to reduce anginal symptoms, increase quality of life, and reduce the risk of fatal and nonfatal cardiovascular events. A comparative effectiveness review was conducted to synthesize the evidence surrounding the additional cardiovascular benefits from adding ACEIs and/or ARB therapy to the long-term care regimens of stable IHD patients with intact LVSF, and if those benefits outweigh the potential side effects of these drugs. This case study will seek to evaluate ACEIs and/or ARBs in stable ischemic heart disease patients with preserved LVSF.