Evaluation of the effect of angiotensin converting enzyme inhibitors and angiotensin receptors blockers on aspirin antiplatelet effect

Objective: Cardiovascular disease (CVD) is one of the major burdens on societies and healthcare systems. Antiplatelet aspirin is used to prevent the occurrence or reoccurrence of cardiovascular events. However, studies have shown that a good portion of patients still suffer from cardiovascular events in spite of using aspirin (also called aspirin nonresponders). On the other hand, angiotensin-converting enzyme inhibitors (ACEIs) as well as angiotensin-receptor blockers (ARBs) are widely used in patients with different spectrums of cardiovascular diseases. In this study, the possible interactive effect of ACEIs and ARBs on aspirin response was evaluated in vitro. Methods: A multiplate analyzer was used to assay the possible interactions between ACEIs and ARBs drugs on antiplatelet effect of aspirin using blood obtained from 6 healthy volunteers. Means of area under the aggregation curves (AUCs) of the blood samples treated with 10 mu g/mL aspirin were calculated before and after exposure to captopril, lisinopril, candesartan, or losartan. Results: Results showed potential antithrombotic effect of ACEIs and ARBs only at high concentrations (3.3 mu g/mL).The antiplatelet effect of aspirin 10 mu g/mL was significantly enhanced by the addition of captopril or lisinopril at high dose (3.3 mu g/mL), candesartan at all tested doses (0.03 mu g/mL, 0.33 mu g/mL, 3.3 mu g/mL), and losartan at doses of 0.33 mu g/mL and 3.3 mu g/m. Conclusion: Treatment with ACEIs (captopril and lisinopril) and ARBs (candesartan and losartan) improved the antiplatelet response to aspirin. Further studies are needed to confirm this action and potentially apply it to clinical practice.