The clinical effectiveness of
angiotensin-converting enzyme (ACE) in the prevention and treatment of cardiovascular disorders partially results from its anti-inflammatory action. No previous study has investigated the effect of any
ACE inhibitor on lymphocyte
cytokine release. In this study, we compared the effects of serum- and tissue-type
angiotensin-converting enzyme inhibitors on systemic
inflammation and lymphocyte secretory function in normotensive patients with stable
coronary artery disease. The study included 134 patients with
coronary artery disease who were randomized into one of three groups and treated with
enalapril (20 mg/d, n = 47),
perindopril (4 mg/d, n = 45) or placebo (n = 42), respectively. The control group included 40 age-, sex- and weight-matched healthy subjects. The plasma
lipid profile,
glucose metabolism markers,
hsCRP and lymphocyte
cytokine release were examined at the beginning of the study and after 30 and 90 days of treatment.
Phytohemagglutinin-stimulated T cells released significantly more
interleukin-2,
interferon-γ and TNFα than the lymphocytes of control subjects. Neither
enalapril nor
perindopril treatment was associated with any significant changes in blood pressure.
Perindopril treatment inhibited lymphocyte
cytokine release and systemic
inflammation, while the effect of
enalapril was insignificant.
Perindopril, and, to a lesser extent,
enalapril, strongly reduced lymphocyte
cytokine release in
insulin-resistant but not
insulin-sensitive subjects. Our results indicate that
perindopril is superior to
enalapril in producing lymphocyte-suppressing and systemic anti-inflammatory effects in normotensive
coronary artery disease patients. These effects may contribute to a reduction in the vascular risk of this group of patients, particularly in those subjects who are resistant to
insulin, when these patients are treated with tissue-type
angiotensin-converting enzyme inhibitors.