Abstract 9641: Effects of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Mortality and Cardiovascular Events in Patients Without Heart Failure. A Meta-Analysis of Randomized Clinical Trials in 108,233 patients
Objective: To verify whether Angiotensin-Converting-Enzyme inhibitors (ACE-Is) and Angiotensin Receptor Blockers (ARBs) reduce cardiovascular (CV) events in patients without left ventricular systolic dysfunction (LVSD).
Methods and Results: MEDLINE, Cochrane, ISI Web of Science and SCOPUS were searched for randomized trials comparing ARBs or ACE-Is versus placebo in patients without LVSD. Twenty-six trials enrolling 108,233 participants were included. The effects of ACE-Is and ARBs were analyzed for the occurrence of a composite outcome including CV death, myocardial infarction (MI) and stroke as well for all-cause death, new onset diabetes mellitus and heart failure. Compared to placebo, ACE-Is significantly reduce the risk of the composite outcome (Odds Ratio [OR]:0.831, 95% Confidence Interval [C]I:0.748 to 0.922, p=0.001)(Figure), MI (OR:0.835, CI:0.781 to 0.894, p<0.001), stroke (OR:0.796, CI:0.685 to 0.924, p<0.003), all-cause death (OR:0.908, 95% CI:0.845 to 0.975, p=0.008), new onset heart failure (OR:0.753, CI:0.679 to 0.834, p<0.001) and diabetes mellitus (OR:0.812, CI:0.706 to 0.932, p<0.001), whereas reduction of CV death approximated statistical significance (OR:0.892, CI:0.783 to 1.017, p=0.087). ARBs significantly reduce the risk of the composite outcome (OR:0.936, CI:0.888 to 0.987, p=0.014)(Figure), stroke (OR:0.909, CI:0.840 to 0.983, p=0.017) and new onset diabetes mellitus (OR:0.854, CI:0.797 to 0.915, p<0.001), but not MI, CV death, new onset heart failure and all-cause death.
Conclusions: In patients at high CV risk but without LVSD, ACE-Is and ARBs reduce the risk of the composite outcome including CV death, MI and stroke, and of new onset diabetes mellitus. At variance with ACE-Is, no significant effects on all-cause death, MI and new onset heart failure are observed for ARBs. Thus, ACE-Is should represent the first choice to reduce CV mortality/morbidity in high-risk patients.
- © 2012 by American Heart Association, Inc.