Clinical Research
Cardiovascular Risk
A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure

https://doi.org/10.1016/j.jacc.2012.10.011Get rights and content
Under an Elsevier user license
open archive

Objectives

The goal of the study was to assess the effects of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) on the composite of cardiovascular (CV) death, myocardial infarction (MI), and stroke, and on all-cause death, new-onset heart failure (HF), and new-onset diabetes mellitus (DM) in high-risk patients without HF.

Background

ACE-Is reduce CV events in high-risk patients without HF whereas the effects of ARBs are less certain.

Methods

Twenty-six randomized trials comparing ARBs or ACE-Is versus placebo in 108,212 patients without HF were collected in a meta-analysis and analyzed for the risk of the composite outcome, all-cause death, new-onset HF, and new-onset DM.

Results

ACE-Is significantly reduced the risk of the composite outcome (odds ratio [OR]: 0.830 [95% confidence interval (CI): 0.744 to 0.927]; p = 0.001), MI (OR: 0.811 [95% CI: 0.748 to 0.879]; p < 0.001), stroke (OR: 0.796 [95% CI: 0.682 to 0.928]; p < 0.004), all-cause death (OR: 0.908 [95% CI: 0.845 to 0.975]; p = 0.008), new-onset HF (OR: 0.789 [95% CI: 0.686 to 0.908]; p = 0.001), and new-onset DM (OR: 0.851 [95% CI: 0.749 to 0.965]; p < 0.012). ARBs significantly reduced the risk of the composite outcome (OR: 0.920 [95% CI: 0.869 to 0.975], p = 0.005), stroke (OR: 0.900 [95% CI: 0.830 to 0.977], p = 0.011), and new-onset DM (OR: 0.855 [95% CI: 0.798 to 0.915]; p < 0.001).

Conclusions

In patients at high CV risk without HF, ACE-Is and ARBs reduced the risk of the composite outcome of CV death, MI, and stroke. ACE-Is also reduced the risk of all-cause death, new-onset HF, and new-onset DM. Thus, ARBs represent a valuable option to reduce CV mortality and morbidity in patients in whom ACE-Is cannot be used.

Key Words

ACE-I
angiotensin-converting enzyme inhibitor
angiotensin receptor blocker
ARB
clinical events

Abbreviations and Acronyms

ACE-I
angiotensin-converting enzyme inhibitor
ARB
angiotensin receptor blocker
CI
confidence interval
CV
cardiovascular
DM
diabetes mellitus
HF
heart failure
IR
incidence rate
MI
myocardial infarction
OR
odds ratio

Cited by (0)

Dr. Cleland has received research funding from Servier, Amgen, and Philips; speakers' honoraria from Medtronic and St. Jude; and has participated in Trial Steering Committees with Amgen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first two authors contributed equally to this work.