Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Coronary Artery Disease without Heart Failure in the Modern Statin Era: a Meta-Analysis of Randomized-Controlled Trials

Hoang, Vu; Alam, Mahboob; Macedo, Francisco; Virani, Salim S.; Birnbaum, Yochai

doi:10.1007/s10557-016-6652-7

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…This suggests a protective effect of ACEI on myocardial systolic function. Previous metaanalyses have shown that ACEIs have multiple potential cardioprotective effects: controlling blood pressure and reducing LV hypertrophy as well as potentially exerting anti-atherosclerotic effects [26,27]. Furthermore, the mechanism of in uencing the coronary artery is an improvement in endotheliumdependent vasodilatation by increasing the level of bradykinin, increasing the expression and activity of nitric oxide synthase and reducing the production of smooth muscle proliferators [28].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

Han¹,

Cao²,

et al. 2020

Preprint

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Background: Computed tomography feature tracking (CT-FT) has emerged as a valuable method for the assessment of cardiac function. However, no studies have investigated the usefulness of CT-derived assessments of left ventricular (LV) strain in coronary artery disease (CAD). Our aim was to evaluate regional LV systolic deformation in patients with left anterior descending coronary artery (LAD) stenosis using CT-FT.Methods: Seventy-six patients with LAD stenosis were enrolled. The patients were divided into four groups according to the percentage of LAD stenosis: ≤25% was defined as group I (24 patients), 26% to 49% as group II (17 patients), 50% to 74% as group III (21 patients), and ≥75% as group IV (14 patients). Thirty-two sex- and age-matched healthy subjects were included as controls.Results: No intergroup differences were found between groups I-IV and the controls in terms of the left ventricular ejection fraction, end-diastolic volume and end-systolic volume. However, the longitudinal strain (LS) of the LAD territory was significantly reduced in groups I-IV compared with the controls (-20.8%, -18.6%, -18.6%, and -17.0% vs -23.7%, respectively). The circumferential strain (CS) of the LAD territory was significantly reduced in groups III and IV compared with the controls and groups I and II (-22.4% and -22.1% vs -25.4%, -24.1%, and -25.3%, respectively). Compared with the non-LAD territory, the LAD territory in groups II-IV showed significantly increased LS (-18.6% vs -21.9%, p=0.07; -18.6% vs -21.9%, p=0.024; -17.5% vs -20%, p=0.032, respectively). The severity of LAD stenosis was positively correlated with the LS of the LAD territory (r = 0.438, p=0.002).Conclusion: CT‑FT can detect decreasing LV systolic function in patients with LAD stenosis. LV regional systolic deformation of the LAD territory was reduced with increasing LAD stenosis severity.

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Section: Discussionmentioning

confidence: 99%

Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

Han¹,

Cao²,

et al. 2020

Preprint

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“…The cholesterol-independent or "pleiotropic" effects of statins include the upregulation and activation of endothelial NO synthase, especially in the presence of hypoxia [22,23]. One meta-analysis study [24] demonstrated that the percentage of patients on statin therapy showed no significant relationship with the reduction in outcomes due to ACEI. In addition, in the ARB trials, no statistical significance was found in terms of outcome and percentage of patients on statin therapy.…”

Section: Discussionmentioning

confidence: 99%

A comparison between statin with ACE inhibitor or ARB therapy in STEMI patients who underwent successful PCI with drug-eluting stents

et al. 2019

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“…Interestingly, Hoang et al performed a meta-analysis based on randomized control trials to investigate the effects of statin use combined with use of ACEIs and ARBs on cardiovascular disease prevention. They noted that the effect of ACEIs/ARBs in reducing cardiovascular morality was attenuated after adjusting for statin use [ 1 ]. This finding supports that the combined use of statins and ACEIs/ARBs might have interactions that cannot be neglected in reducing pneumonia, which needs to be further investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Angiotensin-converting enzyme inhibitors (ACEIs) / Angiotensin receptor blockers (ARBs) and statins are widely used to treat patients with cardiovascular diseases to modify primary and secondary risks. These medications have demonstrated beneficial effects in improving outcomes in patients with cardiovascular diseases [ 1 , 2 ]. Hypertension and hyperlipidemia are prevalent among cardiovascular patients; therefore, the combined use of these two kinds of medications is not uncommon in clinical scenarios.…”

Section: Introductionmentioning

confidence: 99%

Do outpatient statins and ACEIs/ARBs have synergistic effects in reducing the risk of pneumonia? A population-based case-control study

et al. 2018

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Whether statins and an angiotensin-converting enzyme inhibitors (ACEIs) / angiotensin receptor blockors (ARBs) are associated with reduced risks of infection events is still inconclusive. This study aimed to explore the risk of hospitalization for pneumonia among patients who had received treatment with ACEIs/ARBs and/or statins using a population-based dataset. This study included 19,281 patients as cases who were hospitalized for pneumonia and 19,281 controls. We used a logistic regression to compute the odds ratio (OR) and 95% confidence interval (CI) for having previously used statins or an ACEI/ ARB between patients who were hospitalized for pneumonia treatment and controls. We found there were significant associations between hospitalization for pneumonia and statin-only users (p<0.001), ACEI/ARB-only users (p<0.001), and statin and ACEI/ARB users (p<0.001). The logistic regression analysis suggested that statin-only users (adjusted OR = 0.38, 95% CI = 0.34~0.43), ACEI/ARB-only users (adjusted OR = 0.86, 95% CI = 0.82~0.91), and statin and ACEI/ARB users (adjusted OR = 0.47, 95% CI = 0.44~0.50) were all less likely to be hospitalized for pneumonia treatment than were non-users. Furthermore, we found that statin-only users (adjusted OR = 0.44, 95% CI = 0.40~0.50) and statin and ACEI/ARB users (adjusted OR = 0.55, 95% CI = 0.52~0.58) were less likely to be hospitalized for pneumonia treatment compared to ACEI-only users. However, combined statin and ACEI/ARB users (adjusted OR = 1.24, 95% CI = 1.10~1.40) were more likely to have been hospitalized for pneumonia treatment compared to statin-only users. Although we found use of both statins and ACEI/ARB were significantly associated with a lower risk of pneumonia, the combination of the two medications did not provide additional protection against pneumonia risk.

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Efficacy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Coronary Artery Disease without Heart Failure in the Modern Statin Era: a Meta-Analysis of Randomized-Controlled Trials

Abstract: In CAD patients without HF, ACEi, but not ARBs decreases the risk of non-fatal MI, cardiovascular mortality and all-cause mortality, while both ACEi and ARBs decrease the risk of stroke.

Cited by 22 publications

References 40 publications

Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

A comparison between statin with ACE inhibitor or ARB therapy in STEMI patients who underwent successful PCI with drug-eluting stents

Do outpatient statins and ACEIs/ARBs have synergistic effects in reducing the risk of pneumonia? A population-based case-control study

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