Angiotensin‐converting enzyme inhibitors and survival in women and men with heart failure

Keyhan, Golyar; Chen, Shun-Fu; Pilote, Louise

doi:10.1016/j.ejheart.2007.03.004

Cited by 26 publications

(16 citation statements)

References 39 publications

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“…Nonetheless, the present review raises the question of whether ACEIs are equally efficacious in men and women. While the review focused on the management of hypertension, previous population-based studies examining potential sex differences in ACEI efficacy in the treatment of congestive heart failure, it also found that men on ACEIs receive more benefit with respect to mortality reduction than women on ACEIs (40,41).…”

Section: Discussionmentioning

confidence: 99%

Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy

Rabi¹,

Khan²,

Vallée³

et al. 2008

Canadian Journal of Cardiology

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C ardiovascular disease (CVD) is the leading cause of death among Canadian women. Hypertension is an established and prevalent risk factor for CVD, affecting more than one in five Canadian adults (1,2). In the Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (INTERHEART) study (3), hypertension contributed to 29% of the population attributable risk for acute myocardial infarction in women compared with 15.9% with men, in part because the women were approximately one decade older. The prevalence of hypertension differs among men and women, as does the risk of CVD. Men develop clinically significant hypertension earlier, and among men 18 to 34 years of age, one in 10 are hypertensive compared with 2% of women; however, beyond 65 years of age, over 50% are hypertensive, and the prevalence of hypertension in women remains greater than in men (4).In addition to sex differences in epidemiology, there is evidence that there may be sex differences in the pathophysiology of hypertension. The renin-angiotensin system (RAS) plays a significant, if not central, role in the regulation of blood pressure (5,6). Endogenous sex hormones have been shown to interact with the RAS (Table 1). Androgens have been shown to upregulate the RAS and appear to produce an overall vasopressor effect (7). Estrogens, however, are in some way protective, with indirect evidence from an inverse relationship between the age of menopause and blood pressure (8). Also, the RAS is overall antagonized by estrogens (9). BACKGROUND: Clinical practice recommendations for hypertension do not make recommendations specific to men or women. However, the sex hormones appear to modulate differently the renin-angiotensin system (RAS), which plays a central role in the regulation of blood pressure. Today, little is known about the effects of sex on the efficacy of therapies that antagonize the RAS, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). OBJECTIVE: To identify randomized controlled trials evaluating the efficacy of ACEIs and ARBs in preventing major cardiovascular outcomes, determine what proportion of the trial participants were female, and evaluate whether there was any evidence of a sex difference in the efficacy of these agents. METHODS: A systematic review of the literature was conducted to identify randomized controlled trials that used either ACEIs or ARBs for the treatment of hypertension. RESULTS: Thirteen ACEI trials and nine ARB trials were identified. Sex-specific outcome data were available in six of the ACEI trials and three of the ARB trials. These trials enrolled 74,105 patients; 39.1% were women. Seven of the nine trials indicated that ACEIs or ARBs may be slightly more beneficial in men. The magnitude of these differences, in most trials, was small. CONCLUSIONS: Sex-specific data are reported in 43% of large hypertension clinical trials. Review of the trials reporting sex-specific effect sizes indicates that ACEIs and ARBs may be more eff...

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Section: Discussionmentioning

confidence: 99%

Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy

Rabi¹,

Khan²,

Vallée³

et al. 2008

Canadian Journal of Cardiology

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“…10 ACE inhibitors may also have a greater benefit for men than for women, especially asymptomatic LV dsyfunction. 11, 12 The effective dose of ACE inhibitors has been studied in several controlled trial. Although the benefit in mortality may be similar at higher vs. lower doses, 13 the use of higher doses decreased the combined endpoint of mortality and hospitalizations.…”

Section: Current Phramacological Targets Of Systolic Hfmentioning

confidence: 99%

Contemporary Medical Management of Systolic Heart Failure

Nair

Timoh

Fuster

2012

Circ J

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Pharmacological therapy of systolic left ventricular dysfunction has evolved over the past 3 decades. Current therapy is focused primarily on the regulation of the renin-angiotensin-aldosterone axis and sympathetic nervous system. Additional targets of pharmacotherapy include vasoconstriction, impaired nitric oxide metabolism, inflammation and improving myocardial function. As therapies in chronic systolic heart failure have evolved beyond diuretics and digoxin, so too has mortality improved. Future directions in the management of heart failure include cell-based and genetic therapy, and further refinement of current therapy through genetics.

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“…A recent retrospective study from Quebec linking hospital discharge databases with physician and drug databases identified men (n = 13,144) and women (n = 14,693) with HF and compared 1-year mortality rates among those who filled a prescription for ACE-I (67% of women and 72% of men) to those who never filled such a prescription [68]. A significant survival benefit was noted in men (relative risk: [RR]: 0.70; CI: 0.67-0.75) and in women (RR: 0.80; CI: 0.76-0.85) for those prescribed ACE-I.…”

Section: Angiotensin-converting Enzyme Inhibitorsmentioning

confidence: 99%

“…ACE: Angiotensin-converting enzyme. Data from[68]. Adjusted hazard ratios and 95% CIs of survival in patients with chronic heart failure dispensed prescriptions for ARBs compared with ACE-inhibitors according to sex and the presence or absense of hypertension.…”

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confidence: 99%

Sex differences in response to chronic heart failure therapies

Ghali¹,

Lindenfeld²

2008

Expert Review of Cardiovascular Therapy

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Sex-related differences in clinical and laboratory characteristics, course and prognosis are well documented in patients with heart failure. However, most information regarding heart failure therapies has been obtained from studies conducted primarily in men. Reviewing the existing literature indicates that the recommendations regarding pharmacological and device therapies should apply similarly to men and women. One possible exception, however, is the possibility of more benefit derived from angiotensin receptor blockers in women, and from angiotensin converting enzyme inhibitors in men. Future clinical trials should be conducted either exclusively in women or have a larger representation of women to insure the adequate assessment of the potential benefit versus risk in women.

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Angiotensin‐converting enzyme inhibitors and survival in women and men with heart failure

Cited by 26 publications

References 39 publications

Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy

Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy

Contemporary Medical Management of Systolic Heart Failure

Sex differences in response to chronic heart failure therapies

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