Key result
ARBs were not inferior to ACEIs in reducing cardiocerebrovascular disease incidence, significantly reducing heart failure by 52% but increasing cerebrovascular disease by 62%.
Why the study?
Although both ACEIs and ARBs effectively manage cardiovascular disease, more evidence supports ACEIs, prompting an evaluation of cardiovascular outcomes between low-compliance ACEIs and high-compliance ARBs in clinical practice.
Does ARB use reduce the incidence of cardiocerebrovascular disease compared to ACEI use in a real-world clinical setting?
Cohort (n=12,134)
Yes
Does ARB use reduce the incidence of cardiocerebrovascular disease compared to ACEI use in a real-world clinical setting?
Effect estimate: HR 0.48 (95% CI 0.39-0.60)
p-value: p=<0.001
In a real-world setting, ARBs were associated with a lower incidence of heart failure but a higher incidence of cerebrovascular disease compared to ACEIs, with no significant difference in overall MACE.
BACKGROUND: Both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are known to be effective in managing cardiovascular diseases, but more evidence supports the use of an ACEI. This study investigated the difference in cardiovascular disease incidence between relatively low-compliance ACEIs and high-compliance ARBs in the clinical setting. METHODS: Patients who were first prescribed ACEIs or ARBs at two tertiary university hospitals in Korea were observed in this retrospective cohort study for the incidence of heart failure, angina, acute myocardial infarction, cerebrovascular disease, ischemic heart disease, and major adverse cardiovascular events for 5 years after the first prescription. Additionally, 5-year Kaplan-Meier survival curves were used based on the presence or absence of statins. RESULTS: Overall, 2,945 and 9,189 patients were prescribed ACEIs and ARBs, respectively. When compared to ACEIs, the incidence of heart failure decreased by 52% in those taking ARBs (HR [95% CI] = 0.48 [0.39-0.60], P < 0.001), and the incidence of cerebrovascular disease increased by 62% (HR [95% CI] = 1.62 [1.26-2.07], P < 0.001). The incidence of ischemic heart disease (P = 0.223) and major adverse cardiovascular events (P = 0.374) did not differ significantly between the two groups. CONCLUSIONS: ARBs were not inferior to ACEIs in relation to reducing the incidence of cardiocerebrovascular disease in the clinical setting; however, there were slight differences for each disease. The greatest strength of real-world evidence is that it allows the follow-up of specific drug use, including drug compliance. Large-scale studies on the effects of relatively low-compliance ACEIs and high-compliance ARBs on cardiocerebrovascular disease are warranted in the future.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2023) conducted a cohort in Patients prescribed ACEIs or ARBs (n=12,134). Angiotensin II receptor blockers (ARBs) vs. Angiotensin-converting enzyme inhibitors (ACEIs) was evaluated on Incidence of heart failure (HR 0.48, 95% CI 0.39-0.60, p=<0.001). ARBs were not inferior to ACEIs in reducing cardiocerebrovascular disease incidence, significantly reducing heart failure by 52% but increasing cerebrovascular disease by 62%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: