Angiotensin II receptor blockers versus angiotensin-converting enzyme inhibitors in patients with stable coronary artery disease: Prevalence, correlates, and prognostic impact (from the CORONOR study)
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- 作者：Gilles Lemesle ; MDa ; b ; Nicolas Lamblin ; MDa ; b ; c ; Thibaud Meurice ; MDd ; Olivier Tricot ; MDe ; Christophe Bauters ; MDa ; b ; c ; christophe.bauters@chru-lille.fr
- 关键词：Angiotensin ; Coronary artery disease ; Secondary prevention
- 刊名：Journal of Cardiology
- 出版年：2017
- 出版时间：March 2017
- 年：2017
- 卷：69
- 期：3
- 页码：542-547
- 全文大小：433 K
- 卷排序：69
文摘
In international guidelines for patients with stable coronary artery disease (CAD), angiotensin-converting enzyme inhibitors (ACE-I) are recommended while angiotensin II receptor blockers (ARB) are proposed as an alternative in case of intolerance. There are no real-life data on the frequency and correlates of ARB use in this setting.MethodsWe studied 3363 outpatients included in a prospective registry on stable CAD (the CORONOR study) and receiving an ARB or an ACE-I at inclusion.ResultsAltogether, 944 patients received an ARB (28.1%). Factors positively and independently associated with ARB use versus ACE-I use were a history of hypertension, the absence of prior myocardial infarction, age, female gender, estimated glomerular filtration rate <60 ml/min/m2, and left ventricular ejection fraction ≥40%. In the whole study population, the hazard ratio (HR) for the combined endpoint (cardiovascular death, myocardial infarction, stroke) of patients with ARB use was 0.95 (0.69–1.31) (p = 0.765) (patients with ACE-I use as reference). Similar results were observed when the analysis was restricted to a propensity-matched cohort: HR = 0.91 (0.62–1.34) (p = 0.632).ConclusionsOur study shows that a significant proportion of stable CAD patients are treated with ARB rather than with ACE-I in modern practice. Several correlates of ARB prescription were identified. Our results suggest that patients receiving ARB have similar outcome than patients receiving ACE-I.