International Circulation:   It seems like an easy way for patients to be involved in their own care.  You talked about secondary prevention of CAD with ACE inhibitors at this meeting. What is the status of angiotensin receptor blockers (ARBs) in secondary prevention when we look at stable coronary artery disease patients?  Do they have a role? If so， could you tell use more about that role?
《国际循环》：在病情稳定的CAD患者二级预防中，血管紧张素受体拮抗剂ARB的地位如何？他们有作用吗？
 

Roberto Ferrari: I believe that， to prevent the prognosis of a patient with CAD， we do have three certain drugs.  They are aspirin， the ACE inhibitors such as imidapril and ramipril， which have been proven to reduce coronary artery events， and， of course， the statins.  Because the ACE inhibitors counteract the effect of the renin/angiotensin system， it was logical to think that the angiotensin II blockers could have an effect.  In a way， they do have an effect because by reducing blood pressure you are having an effect on the development of CAD but the effect is not of the magnitude of the ACE inhibitors.  That has been demonstrated by many trials and by many meta-analyses， that it is very difficult to reduce the incidence of MI if you use angiotensin II blockers.  The opposite may also be true but this is the result of meta-analyses that need further investigation.  From the mechanistic point-of-view， the big difference is bradykinin because bradykinin is increased by ACE inhibitors and I believe all the good preventative effects of ACE inhibitors are mediated by bradykinin， which is not increased by ARBs. 
Roberto Ferrari: 为改善CAD患者的预后，我们有三类药物：阿司匹林、血管紧张素转换酶抑制剂ACEI（培哚普利和雷米普利，已证明他们能降低冠状动脉事件）和他汀。因为ACEI能对抗肾素血管紧张素系统效应，很容易认为ARB也能产生保护作用。某种程度上，ARB确实有保护作用，因为通过降低血压能阻止CAD进展，但是这种保护作用的程度难以与ACEI相提并论。许多试验和荟萃分析已经证明ARB很难降低心肌梗死发生率，甚至会有相反的结果，我们还需进一步的调查研究。从机制角度来看，ARB与ACEI主要的区别在于缓激肽，因为ACEI能升高缓激肽。我认为ACEI所有的预防作用都是通过缓激肽调节的，但ARB不能升高缓激肽。
 

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