Key result
Long-term use of ACE inhibitors or ARBs was not associated with a reduced risk of atherosclerotic cardiovascular events in patients with lupus nephritis (9.7% vs 8.6%; P=0.708).
Why the study?
Does ACE inhibitor or ARB treatment reduce atherosclerotic cardiovascular events in patients with lupus nephritis?
Case-Control (n=445)
Does ACE inhibitor or ARB treatment reduce atherosclerotic cardiovascular events in patients with lupus nephritis?
Absolute Event Rate: 9.7% vs 8.6%
p-value: p=0.708
Long-term treatment with ACE inhibitors or ARBs does not appear to provide atheroprotective effects against cardiovascular events in patients with lupus nephritis.
ACEi/ARB therapy should not yet be considered for CV prevention in lupus nephritis; leaves open whether RCTs would demonstrate benefit.
OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are used as an adjuvant treatment in lupus nephritis (LN) patients with proteinuria. The primary aim of this study was to discover whether ACE inhibitors/ARBs have an atheroprotective effect similar to other, at-risk, populations. METHODS: A total of 144 patients (cases; mean ± SD age at onset 34 ± 12.1 years, followup 14.9 ± 8.6 years) with LN who were treated with ACE inhibitors/ARBs for at least 5 years were enrolled. The control group comprised 301 LN patients (mean ± SD age at onset 34.1 ± 13.2 years, followup 13.4 ± 7.9 years) with no such treatment. All patients were followed for the occurrence of atherosclerotic cardiovascular events (CVEs), consisting of transient ischemic attack and stroke, angina, myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), and congestive heart failure. Patients with preexisting CVEs were excluded. RESULTS: There were no significant differences in the cumulative occurrence of CVEs (9.7% for treated versus 8.6% for nontreated patients; P = 0.708); however, hard events (stroke, myocardial infarction, CABG, and PTCA) were less frequent in treated patients (4.17% versus 5.32%). Cases were more frequently hypertensive (100% versus 52.8%; P < 0.001) and diabetic (10.4% versus 4.7%; P = 0.021), whereas controls more frequently had hypercholesterolemia (27.9% versus 18.1%; P = 0.024) and elevated triglycerides (14% versus 4.9%; P = 0.004); other variables did not differ significantly. Regression analysis failed to confirm ACE inhibitor/ARB nonuse as an important predictor of future CVEs. CONCLUSION: Our data do not support the hypothesis that ACE inhibitors/ARBs may be protective against atherosclerotic CVEs in LN patients.
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Tselios et al. (2016) conducted a case-control in Lupus nephritis (n=445). ACE inhibitors and angiotensin receptor blockers (ARBs) vs. No ACE inhibitor/ARB treatment was evaluated on Atherosclerotic cardiovascular events (CVEs) (p=0.708). Long-term use of ACE inhibitors or ARBs was not associated with a reduced risk of atherosclerotic cardiovascular events in patients with lupus nephritis (9.7% vs 8.6%; P=0.708).
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