Evolving concept of cardioprotection in myocardial infarction: from SMILE-1 to SMILE-5.

The renin–angiotensin–aldosterone system (RAAS) is a central regulator of cardiovascular (CV) and renal function and plays a key role in the pathophysiology of various CV and renal diseases. Clinical data has demonstrated that ACE inhibitors are very effective at reducing blood pressure in a large proportion of patients with hypertension (HBP), when given alone or in combination. ACE inhibitors improve the clinical prognosis of patients with congestive heart failure (CHF) and AMI, particularly when complicated by overt left ventricular (LV) dysfunction, although their efficacy maybe limited in postmyocardial patients with preserved LV function. Among the different ACE inhibitors, the efficacy of zofenopril has been proven in a wide population of patient and in the different studies. The SMILE project was a large clinical programme aimed at investigating the efficacy of zofenopril for the treatment of patients with AMs with HBP and coronary heart disease, in particular AMI.