Effect of lipid-lowering agents, angiotensin-converting enzyme inhibitors, and calcium antagonists on coronary disease risk

Dyslipidemia is a causative, yet modifiable risk factors for the development of adverse outcomes secondary to coronary artery disease. Recent trials have focused on the level of low-density lipoprotein cholesterol (LDL-C) necessary to achieve maximum reduction in clinical events. Data also exist demonstrating that intensive lowering of LDL-C in patients with unstable angina reduces the incidence of adverse clinical events. The statins appear to be fundamental therapy in patients with established coronary disease as well as a mainstay for those with early evidence of atherosclerosis. The angiotensin-converting enzyme (ACE) inhibitors have demonstrated a reduction in ischemic events in patients with heart failure. Recent trials of ACE inhibitors in patients with vascular disease who do not have the traditional indications for ACE inhibition have shown a reversal of endothelial dysfunction and a reduction in adverse clinical endpoints. A role for the use of calcium antagonists in patients with atherosclerosis is less well established, despite the evidence of excellent results in patients with symptomatic coronary disease. A recent clinical trial, using a third-generation dihydropyridine calcium antagonist with novel mechanisms, found promising results with regard to its effects on atherosclerosis