Key result
ACEI/ARB therapy linked to ~18% lower MACE risk in high-risk patients with preserved EF.
Why the study?
The advantage of ACEI and ARB therapy in patients with preserved LV systolic function is uncertain.
Does ACEI/ARB therapy reduce the composite outcome of nonfatal MI, nonfatal stroke, HF hospitalization, and all-cause death in patients with high atherosclerotic risk and LVEF ≥50%?
Cohort (n=4,246)
Yes
Does ACEI/ARB therapy reduce the composite outcome of nonfatal MI, nonfatal stroke, HF hospitalization, and all-cause death in patients with high atherosclerotic risk and LVEF ≥50%?
Effect estimate: HR 0.82 (95% CI 0.70-0.96)
p-value: p=0.011
In patients with high atherosclerotic risk and preserved ejection fraction, ACEI/ARB therapy is associated with a reduced risk of long-term major cardiovascular events, driven primarily by reductions in all-cause mortality and heart failure hospitalizations.
Observed MACE reduction does not support practice change; leaves open need for RCTs to confirm benefit.
The advantage of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with preserved LV systolic function is uncertain. We aimed to investigate the effects of ACEI/ARB in high atherosclerotic risk patients without overt heart failure (HF) on long-term major cardiovascular outcomes (MACEs). The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. The patients with ejection fraction < 50% were excluded. Among 8513 recruited patients, there were 4246 patients included into final analysis after propensity score matching. At 5-years follow-up, Cox regression analysis showed that ACEI/ARB was significantly associated with reduced risk of all-cause mortality or non-fatal myocardial infarction, non-fatal stroke and HF hospitalization (HR 0.82, 95% CI 0.70-0.96, P = 0.011). The benefit was driven by the reduced all-cause mortality and HF. Subgroup analysis demonstrated that ACEI/ARB decreased risk of long-term MACEs in patients with diabetes (HR 0.77, 95% CI 0.63-0.94, P = 0.011) and patients not taking statin (HR 0.57, 95% CI 0.40-0.82, P = 0.002). We demonstrated that the use of ACEI/ARB was associated with reduced risk of long-term MACEs in a large cohort of high atherosclerotic risk patients. Reduction of all-cause mortality and HF were likely the main contributors to the benefit of ACEI/ARB.
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Wongcharoen et al. (2023) conducted a cohort in High atherosclerotic cardiovascular risk (n=4,246). Angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) vs. No ACEI/ARB was evaluated on Composite of nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalization, and death from any causes (4P-MACEs) (HR 0.82, 95% CI 0.70-0.96, p=0.011). ACEI/ARB therapy significantly reduced the risk of long-term major cardiovascular events (HR 0.82) compared to no ACEI/ARB in patients with high atherosclerotic risk and preserved ejection fraction.
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