The clinical and vasoprotective effect of aspirin in patients long receiving therapy with angiotensin-converting enzyme inhibitors

During an open retrospective study, 6-month therapy with angiotensin-converting enzyme inhibitors (ACEl) was performed in 45 males with coronary heart disease (CHD) and manifestations of chronic heart failure (CHF)₁ of them 30 patients additionally received acetyl-salicylic acid in a daily dose of 125 mg. Clinical parameters, exercise tolerance, echocardiographic data and the major endothelial markers: the level of endothelin-1 (ET-1), blood circulating desquamated endotheliocytes (CDE), endothelium-dependent vasodilatation, the level of uric acid, the content of interleukin-8 (1L-8), were followed up. The findings have led to the conclusion that in patients with CHD and manifestations of CHF, contaminant aspirin therapy does not decrease the main clinical effects of ACEl and it contributes to a reduction in the functional class of angina pectoris, in the incidence of paradoxical vasoconstriction of the brachial artery. Aspirin in a daily dose of 0.12 5 fails to have a negative effect on the variations of left ventricular systolic function, on the parameters of brachial vasodilatation, on the changes in the blood levels of ET-1, CDE, 1L-8, and uric acid, but moderately decreases the antihypertensive effect of ACEI at the same time.

chronic heart disease, angiotensin-converting enzyme inhibitors, acetylsalicylic acid, endothelial dysfunction, cytokines

1. NawarskasJJ, Spinier SA. Pharmacotherapy 1998; 18:1041-52.

2. Nguyen KN, Aursnes I, Kjekshus J. Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the Cooperative New Scandinavian Enalapril Survival StudyII (CONSENSUS II). Am J Cardiol 1997;79:115-9.

3. Coats AJS.Enalapril, aspirin interaction fletter J.Am J Cardiol 1997; 80:1122.

4. Leor J, Reicher-Reiss H, Goldbourt U et al. Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors. A cohort study of 11575 patients with coronary artery disease.JAm Coll Cardiol 1999; 33:1920-5-

5. Hall D, Zeitler H, Rudolph W. JAm Coll Cardiol 1992; 20:1549-55-

6. Teerlink JR, Massie BM. The interaction of ACE inhibitors and aspirin in heart failure: tom between tivo lovers.Am HeartJ 1999; 138:193-7-

7. Арутюнов Г.П., Розанов A.В. Некоторые аспекты совместного применения ацетилсалициловой кислоты и ингибиторов АПФ у больных в постинфарктном периоде. Клин. фарм. тер, 2000; 9 (4): 16-8.

8. Siraluddin RA, Miller AB, Geraci SA. Anticoagulation in patient with dilated cardiomiopathy and sinus rhythm: a critical review. J Card Failure 2002; 8 (I): 48-53

9. Nawarskas JJ, Tоwnsend RR, Cirigliano MD, Spinier SA. Effect of aspirin on blood pressure in hypertensive patients taking enalapril orlosartan.Am J Hypertens 1999; 12: 784-9-

10. Guazzi M, Pontone G.Piergiuseppe A.Aspirin vorsnes exercise performans and pulmonare gas exchange in patients with heart failure who are taking angiotensin-converting enzyme inhibitors.Am HeartJ 1999; 138 (138): 254-60.

11. Nawarskas JJ, Spinier SA. Update on the Interaction BetweenAspirin and Angiotensin-Converting Enzyme Inhibitors. Pharmacotherapy 2000; 20 (6): 698-710.

12. AI-Khadra A, Salem D, Rand W. Antiplatelet agents and survival: a cohort analysisfrom the studies of left ventricular Dysfunction (SOLVD) trial. J Am Coll Cardiol 1998; 31:419-25.

13. Isnard R, Baroin J-P, Drobinski G et al. Influence of aspirin on long-term prognosis of patients with ischemic left ventricular systolic dysfunction [abstr]. Circulation 1998; 98 (suppl.I): 1-300.

14. AumègeatV, de Groote P, Meurice T et al. Aspirin and angiotensin converting enzyme inhibitors in 445 patients with moderate congestive heart failure [abstr].J Am Coll Cardiol 1999; 33 (suppl.A): 214A.

15. Moore SAt Steinhubl SR. Aspirin and ACE inhibitors in patients with heart failure: WATCHingfor a potential interaction. Heart Drug 2001; I: 169-75·

16. Беленков ЮН, Мареев BK). Принципы рационального лечения сердечной недостаточности.М: Медиа Медика, 2000; 266 с.

17. Hladovec J, Rossmann P. Circulating endothelial cells isolated together with platelets and the experimental modification of their count in rats. Thromb Res 1973; 3:663-74-

18. Иванова O.B.,Рогоза A.M. и др. Определение чувствительности плечевой артерии к напряжению сдвига на эндотелии как метод оценки состояния эндотелийзависимой вазодилатации с помощью ультразвука высокого разрешения у больных с артериальной гипертонией. Кардиология, 1998;3:37-42.

19. Лагута П.С., Панченко Е.Л. Роль аспирина влечении и профилактике сердечно-сосудистых заболеваний (Обзор литературы). Mv 2002; 11 с.

20. Shimokawa Т., Smith W.L. Prostaglandin endoperoxide synthase the aspirin acetilatyion region.JBiol Chem 1992; 267:12378.

21. Patrono C, Collar B, Dalen J et al. Platelet-active drugs: the relationships among dose, effectiveness, and side effects. Chest 1998; 114:470S-488S.

22. FitzGerald GĄ Oates JA, Haunger J et al. Endogenous biosynthesis of prostacyclin and thromboxane and plateletfunction during chronic administration of aspirin in man. J Clin Invest 1983; 71:676-88.

23. Madan ZM, Sainani GS. Effect of aspirin treatment on plasma levels of keto PGFI " and thromboxane B2.J Assoc Physicians India 1995; 43:597-9

24. Chuang ML, Parker RA, Riley MF et al. Three demensional echocardiography improves accuracy and compensates for sonagrafter inexperience in assessment of left ventriculare ejection fraction. J Am Soc Ecbocardiogr 1999 May; 12: 290-9.

25. Katz SD, Radin M, Graves T et al. Effect of aspirin and ifetroban on skeleta I muscle blood flow in patients with congestive heart failure treated ivith enalapril. f Am Coll Cardiol 1999; 34- 170-6.

26. Davie AP, Love MP, McMurray JJ. Aspirin and aracbidonic acid in patients with heart failure [abstrj. Circulation 1998; 98 (suppl. I): 1-319

27. Lyons D, Webster J, Benjamin N The effect of antihypertensive therapy on local intra-arterial NG-Monomethyl-L-Arginine in patients with essential hypertension, f Hypertens 1994; 12:1074-52.

28. Felsch A, Schror R. Plateled activating factor-induced tissue injury in a neutrophil -perfused preparation is antogonised by bradykinin and ramiprilat. In: GB,Scholkens BA, Scicli AG. (eds). The role of bradykinin in the cardiovascular action of ramipril.MediaMedica, Sussex, 1992; 69-77-29- Vanhoutte PM. Other endothelium-derived vasoactive factors. Circ 1993; 87 (suppl. I): V9-V17-

29. Vanhoutte PM, Boulanger C, Mombouli JV. Endothelium-derived relaxing factors and converting enzyme inhibition. Am J Cardiol 1995; 76:3E-12E.

30. Shimpo M, Ikeda U, Maeda Y et al. Effects of aspirin-like drugs on nitric oxide synthesis in rat vascular smooth muscle cells. Hypertension 2000; 35: 1085

31. Miller VM, Vanhoutte PM. Endothelium-dependent contractions to arachidonic acid are mediated by products of cyclooxigenase. Am f Physiol 1985; 248: H432-H437

32. Akiere Rf, Kiritsy-Roy JF, Catravas JD et al. Acetylcholine-induced contractions in isolated rabbit pulmonary arteries: role of troboxane A2.J Pharm Exp Ther 1986; 236:53541

33. Husain S, Andrews NP, Mulcahy Detal Aspirin improves endothelial dysfunction in atherosclerosis. Circulation 1998; 97: 716-20.

34. Ridker PM, Cushman M, Stampfer MJ et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 97З-9.

35. Farivar S, Brecher P. Salicylate as a transcriptional inhibitor of inducible nitric oxyde syntase in cultured cardiac fibroblasts. J Biol Cbem 1996; 271 (49): 31585-92

36. BolgerAP, Anker SD. Tumor necrosis factor in chronic heart failure: a peripheral view on pathogenesis, clinical manifestations and therapeutic implications. Drugs 2000; 60 (6): 1245-57