Enalapril (ACE inhibitor) for small dogs with cardiac issues?

[JER]

Thanks, foggybok!

I thought this one was interesting too:

An Approach to Asymptomatic Acquired Heart Disease in Dogs

The vet who gave this presentation does prescribe ACEi for MR issues in asymptomatic dogs although he is quite clear that efficacy is questionable.

Also, he says beta-blockers are problematic in terms of dosage for small dogs.

Well… I’m learning a lot.

[Pancakes]

[QUOTE=JER;4192290]
Thanks, foggybok!

I thought this one was interesting too:

An Approach to Asymptomatic Acquired Heart Disease in Dogs

The vet who gave this presentation does prescribe ACEi for MR issues in asymptomatic dogs although he is quite clear that efficacy is questionable.

Also, he says beta-blockers are problematic in terms of dosage for small dogs.

Well… I’m learning a lot. :)[/QUOTE]

Right…the data right now out there says that the efficacy is questionable and the benefits are not clear. Statistically, there is no difference in survival with asymptomatic CVD dogs given enalapril vs. those that get a placebo.
I can’t even say, “well, it won’t hurt” if you wanted to start enalapril too, because that’s not entirely true.

So it’s your educated decision, and I think you wouldn’t be wrong in choosing to do nothing in this case.

[foggybok]

[QUOTE=JER;4192290]
Thanks, foggybok!

I thought this one was interesting too:

An Approach to Asymptomatic Acquired Heart Disease in Dogs

The vet who gave this presentation does prescribe ACEi for MR issues in asymptomatic dogs although he is quite clear that efficacy is questionable.

Also, he says beta-blockers are problematic in terms of dosage for small dogs.

Well… I’m learning a lot. :)[/QUOTE]

Yeah, there is lots to consider…

One thing to consider in all this is that “not shown to be efficacious” is not the same as “shown to be not efficacious”…That’s where the problem is…The veterinary studies were extremely underpowered. If you compare to human trials for cardiovascular drugs, it’s really not surprising that the results were not positive. In human cardiovascular and CHF progression trials, they enroll thousands of patients to provide the statistical power to reach their endpoints. Unfortunately those kinds of studies don’t happen in veterinary medicine…

Another difference between human and animal is that typically the animals effected don’t have many years left… We can extend the life of a human for a long time, but in an elderly dog, even if there was a CV benefit, there’s a limit to what it actually can do in terms of life extension…

so, tough choices…

Best wishes to you and your dog!

[JER]

[QUOTE=Pancakes;4192755]
Right…the data right now out there says that the efficacy is questionable and the benefits are not clear. Statistically, there is no difference in survival with asymptomatic CVD dogs given enalapril vs. those that get a placebo. [/QUOTE]

And some of those studies are done with problematic breeds like the CKCS or Doberman. Very different issues – the CKCS are younger dogs, Dobes have DCM (and are also younger).

My dog is ~15. One study showed that only 8% of all dogs make it past 15. He’s lived his lifespan just fine. I’m not so much worried about how much longer he lives than the quality of his life at this point. He still likes to go for walks, he still likes to bark at big dogs, he still likes to trick my other dog into giving up the favored bed. I wouldn’t want to take any of that away from him for the sake of a few months’ longer life.

[Pancakes]

[QUOTE=JER;4192817]
And some of those studies are done with problematic breeds like the CKCS or Doberman. Very different issues – the CKCS are younger dogs, Dobes have DCM (and are also younger).

My dog is ~15. One study showed that only 8% of all dogs make it past 15. He’s lived his lifespan just fine. I’m not so much worried about how much longer he lives than the quality of his life at this point. He still likes to go for walks, he still likes to bark at big dogs, he still likes to trick my other dog into giving up the favored bed. I wouldn’t want to take any of that away from him for the sake of a few months’ longer life.[/QUOTE]

Exactly! CVD with a genetic factor vs. the natural aging process (I am never surprised to hear an old, small-breed dog with a mitral murmur) is quite different as well. The CKCS dogs are much more likely to develop CHF from their disease than your naturally aging pup.

I like your philosophy. Hey, if it ain’t broken, don’t fix it. Live and let live. When he has a problem, at least you know your options now.

[yellow_daisy]

[QUOTE=foggybok;4192244]
Here’s a nice review from a board certified cardiologist on the use of ACEi in asymptomatic dogs with valve disease. She gives a nice analysis of the studies that were done

http://www.medvet-cves.com/pdf/Enalapril_In_The_Asymptomatic_Patient_With_Chronic_Valvular_Disease.pdf[/QUOTE]

foggybok, that link says “Unfortunately that page can not be found.” Do you think you could find that review again and share it? My dog was just diagnosed with valve disease and it is still at an early stage so I am trying to learn as much as I can before she starts the enalapril. Thank you