This Article Free Full Text (Free PDF) Free References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Meune, C. Articles by Spaulding, C. Search for Related Content PubMed PubMed Citation Articles by Meune, C. Articles by Spaulding, C. Social Bookmarking                         What's this?

Interaction between cyclooxygenase and the renin-angiotensin-aldosterone system: rationale and clinical relevance

Department of Cardiology, Cochin Hospital, Rene Descartes University, Paris, France

Jean-Jacques Mourad

Department of Internal Medicine, Georges Pompidou European Hospital, Paris, France

Jean-François Bergmann

Department of Internal Medicine, Lariboisière Hospital, Paris, France

Christian Spaulding

Department of Cardiology, Cochin Hospital, Rene Descartes University, Paris, France, christian.spaulding{at}cch.ap-hop-paris.fr

Increased understanding of pathophysiological mechanisms of cardiovascular diseases has shown that the renin-angiotensin-aldosterone system (RAAS) is activated in this setting and suggests a central role for the angiotensin-converting enzyme (ACE). ACE transforms angiotensin I (Ang I) to angiotensin II (Ang II), and also promotes the degradation of bradykinin into inactive metabolites. These bradykinins stimulate nitric oxide synthesis and vasodilatator prostaglandin synthesis via a cyclooxygenase (COX) pathway.

COX inhibitors may therefore be deleterious in cardiovascular disease and/or counteract part of ACE inhibitor (ACE-I) efficacy. This has been clearly demonstrated with non-steroidal anti-inflammatory drugs (NSAIDs), including high-dose aspirin, in avoiding their use in such patients. hypertension, coronary artery disease and chronic heart failure (CHF); most guidelines recommend avoiding their use in such patients.

Theoretically, this effect is dose-mediated and the existence of an identical deleterious effect with low-dose aspirin has been an area of intense debate. In this article, we review studies, most of them conducted in CHF, that pointed out such a possible deleterious effect and a counteraction of ACE-Is with low-dose aspirin , using various criteria of assessment.

However, there are no prospective long-term studies that have validated such an effect, and the role of other anti-aggregating agents has not been evaluated. Until such studies are published, the use of low-dose aspirin (100 mg/day) in such patients can be recommended.

Key Words: angiotensin II • angiotensin-converting enzyme • aspirin • heart failure

Journal of Renin-Angiotensin-Aldosterone System, Vol. 4, No. 3, 149-154 (2003)
DOI: 10.3317/jraas.2003.023


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				H. Krum, S. P. Curtis, A. Kaur, H. Wang, S. S. Smugar, M. R. Weir, L. Laine, D. C. Brater, and C. P. Cannon Baseline factors associated with congestive heart failure in patients receiving etoricoxib or diclofenac: multivariate analysis of the MEDAL program Eur J Heart Fail, June 1, 2009; 11(6): 542 - 550. [Abstract] [Full Text] [PDF]

				B. J. Epstein and J. R. Taylor Osteoarthritis: An Update on Data Currently Reshaping Practice Journal of Pharmacy Practice, February 1, 2009; 22(1): 75 - 85. [Abstract] [PDF]

				C. Meune, K. Wahbi, Y. Fulla, A. Cohen-Solal, D. Duboc, I. Mahe, G. Simoneau, J.-F. Bergmann, S. Weber, and S. Mouly Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors Eur J Heart Fail, February 1, 2007; 9(2): 197 - 201. [Abstract] [Full Text] [PDF]

				K. C. Abbott, F. C. Trespalacios, L. Y. Agodoa, A. J. Taylor, and G. L. Bakris {beta}-Blocker Use in Long-term Dialysis Patients: Association With Hospitalized Heart Failure and Mortality Arch Intern Med, December 13, 2004; 164(22): 2465 - 2471. [Abstract] [Full Text] [PDF]