Structural changes in cardiovascular disease.

The growing emphasis on structural alterations in the heart and vasculature as a critical common pathway toward morbidity and mortality in a wide variety of cardiovascular diseases has opened the door to new interventions that might fundamentally affect these processes. Converting enzyme inhibitors, because of their demonstrable effect on both left ventricular and vascular remodeling, are attractive agents to alter the natural history of these diseases. Whether the effect of converting enzyme inhibitors is mediated by a reduction of angiotensin II, an increase in bradykinin, or other local growth factors remains to be established. Other agents may share or complement the actions of angiotensin-converting enzyme (ACE) inhibitors in inhibiting these unwanted remodeling processes. It is clear that the future of therapy for chronic cardiovascular diseases must take into consideration the structural abnormalities that in the past have been given inadequate attention. New and more targeted therapy to alter specific structural changes may profoundly affect the natural history of these diseases.