How Safe Is the Combination of Aspirin and ACE Inhibitors?
Aspirin and angiotensin-converting enzyme (ACE) inhibitors have been proved to reduce mortality and morbidity in patients with coronary artery disease and congestive heart failure. Recent studies, however, have questioned the effectiveness of this combination therapy in treating heart disease. ACE inhibitors promote the release of vasodilating prostaglandins, while aspirin can block the synthesis of these prostaglandins. In theory, these opposing actions may reduce the effectiveness of both agents. Leor and colleagues evaluated the effectiveness of combination therapy in reducing five-year mortality rates in patients with known coronary artery disease. Data from a large coronary artery disease trial were analyzed to identify patients taking an ACE inhibitor alone and those taking combination therapy. The end point was the five-year mortality rate in these patients. The common dose of aspirin used during the study period was 250 mg per day. A total of 1,247 patients were taking ACE inhi
