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Eur Heart J. 2014 Jul;35(26):1760-8. doi: 10.1093/eurheartj/ehu078. Epub 2014 Mar 9.

Renin-angiotensin system antagonists and clinical outcomes in stable coronary artery disease without heart failure.

Author information

1
Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France Hôpital Avicenne, AP-HP, Bobigny, France Université Paris XIII, Bobigny, France.
2
Inserm U-1148, Paris, France.
3
Inserm U-1148, Paris, France Université Pierre et Marie Curie, Paris, France Hôpital Saint-Antoine, AP-HP, Paris, France.
4
Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Hôpital Bichat, AP-HP, Paris, France.
5
Université Paris-Descartes, Paris, France Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
6
Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France.
7
Tokai University School of Medicine, Kanagawa, Japan.
8
Hôpital Avicenne, AP-HP, Bobigny, France Université Paris XIII, Bobigny, France Université Paris-Descartes, Paris, France Hôpital Cochin, AP-HP, Paris, France.
9
University of Michigan Health System, Ann Arbor, MI, USA.
10
Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
11
Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK gabriel.steg@bch.aphp.fr.

Abstract

AIMS:

The aim of this study was to determine whether angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) use is associated with lower rates of cardiovascular events in patients with stable coronary artery disease (CAD) but without heart failure (HF) receiving contemporary medical management.

METHODS AND RESULTS:

Using data from the Reduction of Atherothrombosis for Continued Health (REACH) registry, we examined, using propensity score approaches, relationships between cardiovascular outcomes and ACEI/ARB use (64.1% users) in 20 909 outpatients with stable CAD and free of HF at baseline. As internal control, we assessed the relation between statin use and outcomes. At 4-year follow-up, the risk of cardiovascular death, MI, or stroke (primary outcome) was similar in ACEI/ARB users compared with non-users (hazard ratio, 1.03; 95% confidence interval [CI], 0.91-1.16; P = 0.66). Similarly, the risk of the primary outcome and cardiovascular hospitalization for atherothrombotic events (secondary outcome) was not reduced in ACEI/ARB users (hazard ratio, 1.08; 95% CI, 1.01-1.16; P = 0.04), nor were the rates of any of its components. Analyses using propensity score matching yielded similar results, as did sensitivity analyses accounting for missing covariates, changes in medications over time, or analysing separately ACEI and ARB use. In contrast, in the same cohort, statin use was associated with lower rates for all outcomes.

CONCLUSIONS:

Use of ACEI/ARB was not associated with better outcomes in stable CAD outpatients without HF. The benefit of ACEI/ARB seen in randomized clinical trials was not replicated in this large contemporary cohort, which questions their value in this specific subset.

KEYWORDS:

Angiotensin-II receptor blockers; Angiotensin-converting enzyme inhibitors; Stable coronary artery disease; Statins

PMID:
24616336
PMCID:
PMC5994822
DOI:
10.1093/eurheartj/ehu078
[Indexed for MEDLINE]
Free PMC Article

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