Angiotensin converting enzyme (ACE) inhibitor therapy is of proven value in the therapy of patients with congestive heart failure. More recently, the clinical effectiveness of ACE inhibition for secondary prevention in patients that experienced a myocardial infarction with associated left ventricular dysfunction has been demonstrated. The results of the previous randomized, placebo-controlled studies in patients with impaired left ventricular function (SOLVD and SAVE trials) demonstrated that the long-term use of ACE inhibitor therapy in patients with left ventricular dysfunction without overt heart failure not only reduced mortality and the manifestations of congestive heart failure, but importantly, resulted in a reduction in the incidence of myocardial infarction and other clinical manifestations of coronary artery disease. The Prevention of Events with Angiotension Converting Enzyme Inhibition (PEACE) trial will test whether the addition of the ACE inhibitor, Trandolapril, to standard therapy will reduce the incidence of cardiovascular mortality or non-fatal myocardial infarction in patients with coronary artery disease, but preserved left ventricular function (EF>40%). This is a large simple trial funded by the NIH. The Johns Hopkins Bayview Medical Center clinical site is subcontracted with the George Washington Biostatistics Center which is the Data Coordinating Center for the study. The goal of the study is to determine whether the addition of Trandolapril, an ACE inhibitor, when added to standard therapy will reduce the incidence of cardiovascular mortality, non-fatal MI, or need for coronary artery procedure for revascularization in patients with coronary heart disease and EF>40%. The secondary goal is to determine if the addition of the ACE inhibitor to standard therapy will reduce the incidence of hospitalization for the management of either unstable angina, congestive heart failure, stroke, or cardiac arrhythmia. The clinical progression of peripheral vascular disease to require a surgical procedure or percutaneous angioplasty procedure will also be considered a manifestation of atherosclerotic cardiovascular disease.
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