Key result
ARB use was associated with a 10% lower rate of CVD events compared to ACEI use in patients with established atherosclerosis, but not in those with risk factors alone.
Why the study?
Does ARB use reduce CVD events compared to ACEI use in adults over 45 with known CVD or multiple risk factors?
Observational (n=40,000)
Yes
Does ARB use reduce CVD events compared to ACEI use in adults over 45 with known CVD or multiple risk factors?
Effect estimate: 10% lower rate
In a large observational registry, ARB use was associated with a 10% lower rate of CVD events compared to ACEI use among patients with established atherosclerosis.
Should not yet change ACEI/ARB prescribing; leaves open potential ARB benefit in established atherosclerosis pending RCTs.
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) medications both target the renin–angiotensin system (RAS) and both are recommended in treatment of several types of cardiovascular disease (CVD). However, the optimal choice between these 2 groups of medications for prevention of CVD is not well established. Potier and colleagues1 compared the relative effectiveness of ACEIs versus ARBs for prevention of adverse outcomes in over 40 thousand patients at high cardiovascular risk enrolled in the observational Reduction of Atherothrombosis for Continued Health (REACH) registry. This international registry includes adults over age 45 years with known CVD or with at least 3 risk factors for atherosclerosis; the current analysis includes only those subjects taking an ACEI or ARB at baseline who had 4-year follow-up data. Medical therapy was provided by individual physician practices for standard indications. Baseline conditions included a history of hypertension (91%), heart failure (16%), atrial fibrillation/flutter (11%), coronary artery disease (60%), cerebrovascular disease (26%) and diabetes (49%). Overall, the propensity score adjusted (and matched) results suggest that ARB use is associated with a 10% lower rate of CVD events compared to ACEI use (figure 1). However, this difference was only seen in those with established atherosclerosis, not those with risk factors alone. Figure 1 Risks of outcomes in ACEIs versus ARBs cohorts, in propensity score-adjusted analysis. ACEIs, ACE inhibitors; ARB, angiotensin receptor blockers; CV, cardiovascular; MI, myocardial infarction.1 In the accompanying editorial, Furukawa …
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Catherine M Otto (2017) conducted an observational in High cardiovascular risk (n=40,000). Angiotensin receptor blockers (ARB) vs. Angiotensin converting enzyme inhibitors (ACEI) was evaluated on CVD events (10% lower rate). ARB use was associated with a 10% lower rate of CVD events compared to ACEI use in patients with established atherosclerosis, but not in those with risk factors alone.
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