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(Circulation. 2006;114:6-7.)
© 2006 American Heart Association, Inc.

Editorial

Chronic Kidney Disease

Tipping the Scale to the Benefit of Angiotensin-Converting Enzyme Inhibitors in Patients With Coronary Artery Disease

Peter A. McCullough, MD, MPH

From the Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Mich.

Correspondence to Dr Peter A. McCullough, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, MI 48073. E-mail pmc975@yahoo.com

Key Words: Editorials • coronary artery disease • morbidity • mortality • chronic kidney disease • medical therapy • renin-angiotensin aldosterone system

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a cornerstone of treatment in patients with chronic kidney disease (CKD).¹ Treatment with ACE inhibitors (ACEIs) and angiotensin receptor blockers has been shown to lower blood pressure, reduce proteinuria, and slow the progression of CKD caused by diabetes and other diseases.¹ Approximately 50% of patients with CKD will incur cardiovascular disease (CVD); conversely, 20% of those with CVD meet a definition of CKD, most commonly an estimated glomerular filtration rate of <60 mL/min per 1.73 m², with no other signs of kidney damage (Figure). Clinical trials of patients with CVD often attempt to exclude patients with CKD, given their higher rates of study medication discontinuation, difficulty in clinical and experimental treatment, and potentially unique form(s) of CVD, which may add to variation in trial outcomes. We have learned in recent years that the serum creatinine alone is an insensitive indicator of reduced renal filtration, and the estimated glomerular filtration rate (eGFR) is best obtained from a calculation based on the creatinine, age, gender, and race.² In the Prevention of Events with an ACE Inhibitor (PEACE) trial discussed in the present issue of Circulation,³ a serum creatinine level >2.0 mg/dL was an exclusion criterion. This worked to effectively exclude most patients with an eGFR <30 mL/min per 1.73 m². However, it allowed 1355 of 8280 (16.4%) of patients in the present analysis from PEACE into the study with an eGFR <60 mL/min per 1.73 m², which is considered . . . [Full Text of this Article]

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