Previous research has suggested that ACE inhibitors may be less effective in patients who also receive aspirin for the treatment of cardiovascular disease. Salim Yusuf from McMaster University, Hamilton, Canada, and colleagues did a systematic overview of data from around 22,000 patients from six long-term randomised trials of ACE inhibitors to assess whether aspirin altered the effects of ACE inhibitor therapy on major clinical outcomes (a combination of death, heart attack, stroke, hospital admission for congestive heart failure, or coronary artery revascularisation).

With the exception of one randomised trial, the efficacy of ACE inhibitors was not found to be altered (either positively or negatively) among patients who were also receiving aspirin. Overall, ACE inhibitor therapy significantly reduced the risk of the major clinical outcomes by 22%, with clear reductions in the risk both among those receiving or not receiving aspirin at the start of the randomised trials.

Salim Yusuf comments: "Even though results from the present analyses cannot rule out the possibility of some sort of interaction, they show unequivocally that even if aspirin is given, the addition of ACE inhibitor therapy produced substantial additional benefit in all major vascular outcomes. Therefore, in the absence of clear contraindications, concomitant use of aspirin and ACE inhibitors should be considered in all patients at high risk of major vascular events."

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Contact: Richard Lane
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Lancet
3-Oct-2002