Synergistic actions between angiotensin-converting enzyme inhibitors and statins in atherosclerosis

Nutr Metab Cardiovasc Dis. 2022 Apr;32(4):815-826. doi: 10.1016/j.numecd.2021.11.015. Epub 2021 Nov 30.

Abstract

Aims: Hypertension and hypercholesterolemia are independent risk factors for atherosclerotic cardiovascular disease (ASCVD) by acting directly on the endothelium and activating the renin-angiotensin aldosterone system (RAAS) and mevalonate pathways. This review examines how the severity and duration of these risk factors may influence the cardiovascular risk through a reciprocal interplay leading to oxidative stress and pro-inflammatory response.

Data synthesis: The review highlights the clinical evidence supporting the benefits of statins and angiotensin-converting enzyme (ACE) inhibitors for hypertension, lipid disorders and ASCVD management, both individually and combined, at all stages of the cardiovascular continuum.

Conclusion: Drug strategies incorporating an ACE-inhibitor and a statin, and in particular perindopril and atorvastatin, have consistently demonstrated reductions in the rate of ASCVD events in patients with hypertension and lipid disorders, cementing their position as first-line therapies for the management of atherosclerosis complications.

Keywords: Clinical trials; Hyperlipidemia; Hypertension; Pharmacology.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensins / pharmacology
  • Angiotensins / therapeutic use
  • Atherosclerosis* / drug therapy
  • Atherosclerosis* / prevention & control
  • Atorvastatin / adverse effects
  • Cardiovascular Diseases* / drug therapy
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
  • Hypertension*
  • Renin-Angiotensin System

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensins
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Atorvastatin