Impact of angiotensin receptor blockers on mortality after hospitalization for symptomatic lower extremity artery disease

2020 ◽  
Author(s):  
François-Xavier Lapébie ◽  
Alessandra Bura-Rivière ◽  
Philippe Lacroix ◽  
Joël Constans ◽  
Carine Boulon ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Cox Model ◽  
Angiotensin Receptor Blockers ◽  
Incidence Rates ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Abstract Aims The objective was to assess the association between angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) prescription at discharge in patients hospitalized for symptomatic lower extremity artery disease (LEAD) and 1-year mortality. Methods and results The COPART registry is a multicentre, prospective, observational, cohort study which includes consecutive patients hospitalized for symptomatic LEAD in four French academic centres. All-cause mortality during a 1-year follow-up after hospital discharge was compared between patients with ARB, patients with ACEI and patients without ARB or ACEI. Analyses were performed using Cox models. As a sensitivity analysis, a propensity score (PS)-matching analysis was carried out. Among 1981 patients, 421 had ARB (21.3%), 766 ACEI (38.7%), and 794 no ACEI/ARB (40.1%) at discharge. During the 1-year follow-up, incidence rates for mortality were 12.6/100 person-years [95% confidence interval (CI) 9.7–16.1] for patients with ARB, 15.8/100 person-years (95% CI 13.4–18.6) for patients with ACEI and 19.8/100 person-years for patients without ACEI/ARB (95% CI 17.2–22.8). In a multivariate Cox model, ARB at discharge was associated with decreased mortality compared with no ACEI/ARB, hazard ratio (HR) 0.68 (95% CI 0.49–0.95), and with ACEI, HR 0.69 (95% CI 0.49–0.97). These results are consistent with those obtained by the Cox analyses in the PS-matched sample: HR 0.68 (95% CI 0.47–0.98) for patients with ARB compared with no ARB. Conclusion Angiotensin receptor blockers at discharge after hospitalization for symptomatic LEAD is associated with a better survival compared with ACEI or no ACEI/ARB.

Abstract 19292: The Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Coronary Artery Disease and No Heart Failure in the Modern Statin Era: a Meta-Analysis of Randomized-Controlled Trials

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vu Hoang ◽  
Daniel Addison ◽  
Mahboob Alam ◽  
Salim Virani ◽  
Yochai Birnbaum
Keyword(s):  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Randomized Controlled ◽  
Receptor Blockers ◽  
Artery Disease

Background: Data from randomized-controlled trials regarding the efficacy of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) in patients with coronary artery disease (CAD) but no evidence of heart failure are inconclusive. Current ACC/AHA guidelines support their use in this population. The variation in efficacy of ACEi and ARBs in improving cardiovascular (CV) outcomes may be related to the rising use of statin therapy in the past two decades. Methods: We conducted literature review of randomized-controlled trials with ACEi or ARBs as the single intervention, focusing on studies involving patients with CAD including patients with left ventricular dysfunction but no clinical symptoms of heart failure. The MEDLINE database was searched for publications between 1/1/1980 and 12/31/2012 with searched terms including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, coronary artery disease, cardiovascular events, and myocardial infarction. Of the 1553 potentially relevant publications, 19 (14 ACEi and 5 ARB) met the inclusion criteria for a total of 99,631 randomized patients followed for a mean of 38 months. We evaluated the endpoints of CV mortality, all-cause mortality, non-fatal MI, and stroke. The relationship between endpoints across the 19 trials and the percentage of patients on statins in each trial (with available data) were evaluated using meta-regression analysis, expressed as highest standardized regression coefficient, Beta. Results: ACEi and ARB therapy across the 19 trials was associated with decreased CV mortality (OR 0.85; 95% CI 0.78-0.93) and all-cause mortality (OR 0.92; 95% CI 0.86-0.98). When adjusted for the percentage of statin, 46% of patients in the cohort, there was a significant linear decrease in the odds of CV mortality reduction with ACEi and ARB therapy (Beta = 0.01; p = 0.034). Conclusion: In patients with CAD and no evidence of heart failure, the additive benefits of ACEi and ARBs in decreasing CV mortality are blunted by statin therapy. The exact mechanism(s) for this result is unclear and further investigation is warranted. The modification of current ACC/AHA practice guidelines should be considered.

The Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and the Risk of Developing Venous Thromboembolism in Patients with Atherosclerotic Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1078-1078
Author(s):  
Young Kwang Chae ◽  
Danai Khemasuwan ◽  
Lakshmi Chebrolu ◽  
Shikha Gupta ◽  
Stefan Neagu ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
History Of ◽  
Receptor Blockers ◽  
Ras Inhibitors

Abstract Abstract 1078 Poster Board I-100 Objectives: Arterial and venous thrombosis may share common pathophysiology involving the activation of platelets and inflammatory mediators. A growing body of evidence suggests prothrombotic effect of renin angiotensin system (RAS) including vascular inflammation and platelet activation. We hypothesized that the use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), therefore, plays a role in protecting against venous thromboembolism (VTE) in patients with history of atherosclerosis. Whether ACEIs and ARBs actually prevents VTE has never been studied in a clinical setting. Methods: We conducted a retrospective study, reviewing 596 consecutive patients admitted to Albert Einstein Medical Center (AEMC), Philadelphia with a diagnosis of either myocardial infarction or ischemic stroke during September 2007 to January 2009. Patients were followed up to maximum of 30 months. Patients who had been treated with anticoagulation therapy before or after the first visit at AEMC were excluded. The occurrence of VTE during the follow up period, risk factors for VTE on admission, and use of ACEIs and ARBs during the follow up period were recorded. Results: The mean age of the entire study population was 68.1 years. 52.0% of the patients were female and 76.5% were African American. The overall incidence of VTE was 13.4% (n=80); and 68.8% (n= 410) were on RAS inhibitors [either ACEIs only (n=348, 58.4%) or ARBs only (n=89, 14.9%) or both (n=27, 4.5%)]. Among patients on RAS inhibitors, 11.0 % (45/410) developed a VTE, compared with 18.8% (35/186) in the nonuser group [OR (Odd ratio), 0.53; 95% CI (confidence interval), 0.33 – 0.86; P=0.01]. Even after controlling for factors related to VTE (smoking, history of cancer, and immobilization, hormone use) and diabetes, the use of RAS inhibitors was still associated with lower risk of developing VTE [OR, 0.55; 95% CI, 0.34 – 0.90; P=0.02]. Although statitistically not significant due to small sample size, the OR of VTE for ACEI only users were 0.66 [CI, 0.37-1.16, p=0.15], whereas the OR for ARB only users was 0.75 [CI, 0.30-1.85, p=0.53]. Interestingly, Among patients using both ACEI and ARB, no one developed VTE (0/27), compared with 10.9% (38/348) in ACEI only users and 7.9% (7/89) in ARB only users. Conclusions: The use of RAS inhibitors appears to be associated with a reduction in the risk of VTE. This possible antithrombotic effect of antagonizing RAS warrants further prospective clinical investigation. Disclosures: No relevant conflicts of interest to declare.

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