07 Aug ACE Level Lowered by ACE Inhibitors Can Falsely Rule Out Sarcoidosis
MedicalResearch.com Interview with:
Matthew D. Krasowski MD, PhD
Department of Pathology
University of Iowa, Iowa City, and
Jonathan Genzen, MD, PhD
Department of Pathology
University of Utah, Salt Lake City, UT
Medical Research: What is the background for this study? What are the main findings?
Response: Serum angiotensin converting enzyme (ACE) activity is commonly measured for the diagnosis and management of sarcoidosis. It was well known several decades ago that serum ACE activity is reduced in patients taking ACE inhibitors (e.g., captopril, enalapril, lisinopril, etc.). However, providers ordering ACE levels may be unaware of this interaction and not realize that ACE inhibitor therapy can dramatically lower serum ACE activity (and thus resulting in a misleadingly low ACE level).
The main goal of the study was to determine how often serum ACE levels were performed in patients prescribed ACE inhibitors. Using electronic medical record review at an academic medical center, it was determined that 8.4% of serum ACE levels were ordered on patients currently on ACE inhibitors. The group of patients on ACE inhibitors had significantly lower serum ACE activity than the other patients. Analysis of samples at a national reference laboratory arrived at a similar estimate. This analysis included detection of lisinopril in a subset of serum samples with very low ACE activity. At the academic medical center, the use of targeted warning prompts and alerts greatly reduced the frequency of ordering serum ACE activity in patients on ACE inhibitors.
Medical Research: What should clinicians and patients take away from your report?
Response: Clinicians and patients should be aware that the serum ACE assay measures enzyme activity and and is therefore lowered by ACE inhibitor therapy. Consequently, the serum ACE activity assay is unreliable in patients currently prescribed ACE inhibitors such as captopril or lisinopril. Failure to recognize this interaction can result in misleading test results and potentially the erroneous exclusion of sarcoidosis as a possible diagnosis for a patient.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Future research can focus on interventions within electronic medical records to help prevent situations such as ordering serum ACE assays in patients on ACE inhibitors.
Citation:
Krasowski MD, Savage J, Ehlers A, et al.
CHEST Published online July 30, 2015.
doi:10.1378/chest.15-1061.
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Matthew D. Krasowski MD, PhD and Jonathan Genzen, MD, PhD (2015). ACE Level Lowered by ACE Inhibitors Can Falsely Rule Out Sarcoidosis
Last Updated on August 7, 2015 by Marie Benz MD FAAD