ACE inhibition in asymptomatic MR dogs: results from a 4 year prospective, double blind, placebo controlled, monotherapy trial (SVEP = scandinavian veterinary enalapril prevention trial)

摘要

There are convincing evidence that angiotensin converting enzyme inhibition (ACE-I) and especially enalapril has beneficial effects on survival and improves quality of life when added to other therapy for CHF in people (Consensus study and SOLVD study) and dogs (Improve, Cove and Live study) However, no investigation has, hitherto, shown that ACE-I would be beneficial for preventing CHF in asymptomatic dogs with mitral regurgitation (MR) attributed to chronic valvular disease (CVD). The SVEP trialwas planned in 1994 for multiple reasons: 1) Reports had been published that proved a delayed in onset of CHF and decreased the need for hospitalization in people when an ACE inhibitor was administered to patients with mild degree of heart failure (SOLVD). 2) Increased plasma renin levels had been found in some asymptomatic dogs with MR, which indicated early activation of RAAS, 3) The importance of local cardiac RAAS systems were discussed widely in scientific journals and at cardiology meetings. Earlier studies concerning cavalier King Charles spaniels had revealed a very high prevalence of MR caused by CVD in middle age animals. Therefore, this breed is well suited to studying the pharmaceutical effects of different drugs on naturally occurring CHF.Treatment and placebo/control groups can also readily be balanced. Another important reason to undertake the SVEP trial were publications with confusing use of heart failure classes which may give the erroneous impression that ACE inhibition is proven effective as prophylaxis for CHF in asymptomatic animals.