Key result
Prior ACEI/ARB linked to ~17% lower MACCE risk in diabetic hypertensive patients with obstructive CAD.
Why the study?
The effects of using ACEI/ARB before the initial diagnosis of obstructive coronary artery disease on MACCE in diabetic hypertensive patients remain unclear.
Does the use of ACEI/ARB before the initial diagnosis of obstructive coronary artery disease reduce MACCE in diabetic hypertensive patients?
Observational (n=2,501)
No
Does the use of ACEI/ARB before the initial diagnosis of obstructive coronary artery disease reduce MACCE in diabetic hypertensive patients?
Effect estimate: HR 1.21 (95% CI 1.02-1.43)
Absolute Event Rate: 23.1% vs 29.7%
p-value: p=<0.05
In diabetic hypertensive patients, ACEI/ARB therapy prior to the diagnosis of obstructive coronary artery disease is associated with reduced infarct size, preserved heart function, and lower rates of MACCE.
May support pre-diagnosis ACEI/ARB in diabetic hypertensives; leaves open need for RCTs to confirm MACCE benefit.
Background: Current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) /angiotensin receptor blockers (ARB) as a first-line therapy in diabetic hypertensive patients and for secondary prevention in patients with obstructive coronary artery disease (OCAD). However, the effects of using ACEI/ARB before the initial diagnosis of OCAD on major adverse cardiac and cerebral event (MACCE) in diabetic hypertensive patients remain unclear. This study investigated whether using ACEI/ARB before the initial diagnosis of OCAD could be associated with improved clinical outcomes in diabetic hypertensive patients. Methods: A total of 2501 patients with hypertension and diabetes, who were first diagnosed with OCAD by coronary angiography, were included in the analysis. Of the 2501 patients, 1300 did not used ACEI/ARB before the initial diagnosis of OCAD [the ACEI/ARB(-) group]; 1201 did [the ACEI/ARB(+) group]. Propensity score matching at 1:1 was performed to select 1050 patients from each group. Incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, heart function, and subsequent MACCE during a median of 25.4-month follow-up were determined and compared between the 2 groups. Results: Compared with the ACEI/ARB(-) group, the ACEI/ARB(+) group had significantly lower incidence of AMI (22.5% vs. 28.4%, p<0.05), smaller infarct size in patients with AMI (pTNI: 5.7 vs. 6.8 ng/ml, p<0.05; pCKMB: 21.7 vs. 28.7 ng/ml, p<0.05), better heart function (LVEF: 60.0 vs. 58.5%, p<0.05), and lower incidences of non-fatal stroke (2.4% vs. 4.6%, p<0.05) and composite MACCE (23.1% vs. 29.7%, p<0.05). No prior ACEI/ARB therapy was significantly and independently associated with non-fatal stroke and composite MACCE. Conclusions: In diabetic hypertensive patients, treatment with ACEI/ARB before the initial diagnosis with OCAD was associated with decreased incidence of AMI, smaller infarct size, improved heart function, and lower incidences of non-fatal stroke and composite MACCE. Trial registration: retrospectively registered.
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Zhang et al. (2020) conducted an observational in Hypertension and diabetes with obstructive coronary artery disease (n=2,501). ACEI/ARB vs. No ACEI/ARB was evaluated on Composite MACCE (HR 1.21, 95% CI 1.02-1.43, p=<0.05). Treatment with ACEI/ARB before the initial diagnosis of obstructive coronary artery disease in diabetic hypertensive patients was associated with a lower incidence of composite MACCE (23.1% vs 29.7%) compared to no prior ACEI/ARB therapy.
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