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Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release
  1. D J Brull1,
  2. J Sanders1,
  3. A Rumley2,
  4. G D Lowe2,
  5. S E Humphries1,
  6. H E Montgomery1
  1. 1UCL Centre for Cardiovascular Genetics, Rayne Institute, London, UK
  2. 2Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to:
    Dr D J Brull, UCL Centre for Cardiovascular Genetics, 3rd Floor, Rayne Institute, 5 University Street, London WC1E 6JJ, UK;


Background: Angiotensin 1 converting enzyme (ACE) inhibitors reduce morbidity and mortality after coronary artery bypass graft surgery (CABG). This benefit may result from an anti-inflammatory action.

Objective: To examine the effect of ACE inhibition on interleukin 6 (IL-6) concentrations after CABG.

Patients and methods: 161 patients undergoing elective first time CABG were recruited, of whom 41 (25%) were receiving ACE inhibitor treatment; 21 patients with confounding postoperative complications were excluded. After these exclusions there were 33 patients (24%) on ACE inhibitor treatment. Plasma IL-6 was measured preoperatively and again six hours after CABG.

Results: Baseline IL-6 concentrations (geometric mean (SEM)) were non-significantly lower among the patients receiving ACE inhibitors (3.7 (0.1) v 4.3 (0.1) pg/ml, p = 0.12). Overall, post-CABG IL-6 concentrations increased significantly (mean rise 177 (12) pg/ml, p < 0.0005). This response was blunted among ACE inhibitor treated patients. Median increases in IL-6 concentrations were 117 v 193 pg/ml, for treated v non-treated patients, respectively (Kruskal–Wallis, p = 0.02), with peak postoperative IL-6 concentrations lower among the subjects receiving ACE inhibitors than in untreated subjects (142 (19) v 196 (13) pg/ml, p = 0.02). The effect of ACE inhibitors remained significant after multivariate analysis (p = 0.018).

Conclusions: ACE inhibitor treatment is associated with a reduction in IL-6 response to CABG. The data suggest that this class of drug may have a direct anti-inflammatory effect, which could explain some of its clinical benefit.

  • angiotensin converting enzyme
  • inflammation
  • interleukin 6
  • coronary artery bypass graft
  • ACE, angiotensin converting enzyme
  • CABG, coronary artery bypass graft
  • CASIS, coronary artery surgery inflammation study
  • HOPE, heart outcomes prevention evaluation study
  • IL-6, interleukin 6

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