Effects of low-dose angiotensin II receptor blocker candesartan on cardiovascular events in patients with coronary artery disease

Summary of AHRQ's Comparative Effectiveness Review of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease

“…Twelve studies (N = 41,672 participants), including doubleblind RCTs and open-label designs, met the inclusion criteria for comparing the benefits and harms of ACE inhibitors or ARBs added to standard therapy versus standard therapy alone (or an active comparator) in patients with stable IHD [24][25][26][27][28][29][30][31][32][33] or IHD risk equivalents 34,35 and preserved left ventricular function. The duration of patient follow-up was 6 months in 1 study 32 and 19.4 months to 4.8 years in the other 11 studies.…”

Rationale, Design and Baseline Characteristics of a Study to Evaluate Effects of Candesartan on Cardiovascular Events after Drug-eluting Stent Implantation in Patients with Ischemic Heart Disease

“…Candesartan could reduce cardiovascular events by 50% in patients without restenosis after PCI with BMS 13) . In our present study, however, study subjects in the control group were allowed to use ACEIs; therefore, we estimated that candesartan would reduce the risk of a cardiovascular event by 25%, which is half of the event reduction in the Ogaki study.…”

“…The investigator explained the study to each patient, covering the following points: (1) objectives and methods of the study; (2) scheduled participation period and planned number of participants; (3) anticipated clinical benefits and risks; (4) each patient was free to refuse to participate in the study and can withdraw consent at any time after initiation of the study without any disadvantage; (5) patients will receive rapidly any new information that may affect their willingness to continue participating in the study if such information becomes available; (6) information colwith DES, candesartan started immediately after the procedure should be effective in preventing cardiovascular events similar to the event reduction in patients who survived restenosis after the implantation of BMS 13) . Therefore, the Candesartan for prevention of Cardiovascular events after CYPHER or TAXUS Coronary stenting (4C) trial was designed to evaluate the long-term effects of candesartan on the incidence of cardiac events in patients implanted with DES.…”

“…We chose candesartan for the study drug in the 4C study, because this drug was shown to reduce cardiovascular events (cardiovascular death, non-fatal myocardial infarction and target and/or non-target lesion revascularization) by 53% in patients who survived restenosis after PCI with BMS (Ogaki study) 13) ; however, the use of DES markedly decreases the restenosis rate compared with BMS. Based on the results of the Ogaki study, candesartan could be effective to prevent cardiovascular events by starting the drug immediately after PCI with DES.…”

“…In fact, Kondo et al investigated patients who survived restenosis after PCI with bare metal stents (BMS), and showed that a low dose of candesartan that did not decrease blood pressure reduced the cardiovascular event risk more than 50% when therapy was started about 6 months after the index procedure 13) . Furthermore, it was reported that valsartan inhibited in-stent restenosis after PCI with BMS in patients with complicated morphology in their coronary arteries 14) ; thus, the use of ARBs could represent an important therapeutic strategy to improve the prognosis of patients treated with PCI.…”