From the Guidelines
An ACE test score of 145 is not a valid or recognizable score on the standard Adverse Childhood Experiences (ACE) questionnaire, which only goes up to 10, and therefore, its interpretation and implications are unclear. However, considering the context of the question and the potential for an expanded or modified ACE assessment tool, it's essential to address the potential health implications associated with high levels of adverse childhood experiences. High ACE scores, as typically defined by the standard ACE questionnaire, are associated with an increased risk for numerous health problems, including heart disease, depression, substance abuse, and reduced life expectancy 1.
Given the information provided in the guideline evidence, the management of heart failure, particularly heart failure with reduced ejection fraction (HFrEF), involves the use of renin-angiotensin system inhibitors such as ACE inhibitors, ARBs, or ARNI to reduce morbidity and mortality 1. The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality, and they should be started at low doses and titrated upward to doses shown to reduce the risk of cardiovascular events in clinical trials 1.
It's crucial for individuals with concerns about their ACE score or potential health implications to consult with a healthcare provider for proper evaluation and guidance. Mental health support through therapy, particularly trauma-informed approaches, and developing resilience through social support networks, mindfulness practices, and healthy lifestyle habits can help mitigate the effects of childhood trauma. The connection between childhood adversity and adult health outcomes occurs through stress response systems and behavioral coping mechanisms, making professional intervention important for breaking these patterns.
In the context of heart failure management, as outlined in the guideline evidence, the clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors, ARBs, or ARNI, in conjunction with evidence-based beta blockers and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality 1. This approach is supported by randomized controlled trials that clearly establish the benefits of these interventions in patients with HFrEF.
From the Research
ACE Test of 145
- The ACE test is related to Angiotensin-Converting Enzyme inhibitors, which are used to treat hypertension and other cardiovascular diseases 2, 3, 4, 5, 6.
- Studies have compared the effectiveness of ACE inhibitors with other antihypertensive agents, such as beta-blockers and angiotensin receptor blockers (ARBs) 3, 4, 5, 6.
- A study published in 2023 found that combining beta-blockers with ACE inhibitors can provide effective blood pressure lowering and improved cardiovascular outcomes 3.
- Another study published in 2014 compared the effects of ACE inhibitors and ARBs on total mortality and cardiovascular events in people with primary hypertension, and found no evidence of a difference between the two 4.
- A 2010 study compared the effectiveness of ACE inhibitors and beta-blockers as second-line therapy for hypertension, and found that they were equally effective in lowering blood pressure and preventing cardiovascular events 5.
- The choice of ACE inhibition or beta-blockade as first-line therapy in heart failure is still debated, with some studies suggesting that beta-blockade may be more effective in certain cases 6.
- Overall, the evidence suggests that ACE inhibitors are a effective treatment option for hypertension and other cardiovascular diseases, and can be used in combination with other agents to achieve better outcomes 2, 3, 4, 5, 6.