Coronary artery disease, treatment inhibitors

BRADYKININ AND THE EEFECTS OE ACE INHIBITORS ACE inhibitors are used widely in the treatment of hypertension, and they reduce mortality in patients with diabetic nephropathy, left ventricular dysfunction, previous myocardial infarction, or coronary artery disease. ACE inhibitors block the conversion of Angl to Angll, a potent vasoconstrictor and growth promoter (Figure 24-2) (see Chapter 30). Studies using the specific bradykinin B antagonist HOE-140 demonstrate that bradykinin also contributes to many of the protective effects of ACE inhibitors. The contribution of bradykinin to the effects of ACE inhibitors may result not only from decreased degradation of bradykinin but also from induction of enhanced receptor sensitivity. 

Thadani U, Smith W, Nash S, et al, The effect of vardenafil, a potent and highly selective phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, on the cardiovascular response to exercise in patients with coronary artery disease, J Am Coll Cardiol 2002 40 2006-2012. 

HMG-CoA reductase inhibitors are the drags of first choice for treatment of most patients with hypercholesterolemia. They are more effective and better tolerated than other lipid-lowering drugs, and have been shown to decrease mortality from coronary artery disease. 

Platelet inhibitors are widely used in the treatment and prevention of coronary artery disease. In addition to acetic salicylic acid (ASA), two major groups of platelet inhibitors are used phosphodiesterase inhibitors, including dipyridamole, and thienopyridines. Clopidogrel is the most widely used antiplatelet agent and in combination with ASA, it is the standard-of-care (SoC) for acute coronary s5mdromes and percutaneous coronary interventions. However, the mechanisms of action include pathways that affect the metabolic activity of bone cells and pharmacologic modulation of these pathways may have adverse effects on the bones. 

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