A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure
A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure
复制标题
DOI：
10.1016/j.jacc.2012.10.011
复制
发表时间：
2013-01-15
影响因子：
24
通讯作者：
Perrone-Filardi, Pasquale
中科院分区：
文献类型：
--
作者：
Savarese, Gianluigi;Costanzo, Pierluigi;Perrone-Filardi, Pasquale
目的评价血管紧张素转换酶抑制剂(ACE-IS)和血管紧张素受体阻滞剂(ARB)对心血管(CV)死亡、心肌梗死(MI)和卒中、全因死亡、新发心力衰竭(HF)的影响。在无心衰的高危患者中，血管紧张素转换酶抑制剂可减少心血管事件的发生，而血管紧张素转换酶抑制剂对心血管事件的影响尚不确定。方法在108,212例无心衰的患者中收集26项比较血管紧张素转换酶或血管紧张素转换酶与安慰剂的随机试验，进行荟萃分析，分析综合结果、全因死亡、新发心力衰竭和新发糖尿病的风险。P=0.001)、心梗(OR：0.811[95%CI：0.748~0.879]；P&t；0.001)、卒中(OR：0.796[95%CI：0.682~0.928]；P<；0.004)、全因死亡(OR：0.908[95%CI：0.845~0.975]；P=0.008)、新发心力衰竭(OR：0.789[95%CI：0.686~0.908]；P=0.001)和新发糖尿病(OR：0.851[95%CI：0.749~0.965]；P<；0.012)。ARBS显著降低了综合结果(OR：0.920[95%CI：0.869~0.975]，p=0.005)、卒中(OR：0.900[95%CI：0.830~0.977]，p=0.011)和新发DM(OR：0.855[95%CI：0.798~0.915]；P<；0.001)。结论在心血管风险较高且无心衰、血管紧张素转换酶-IS和ARBS的患者中，心血管死亡、心肌梗死和中风的综合结果的风险降低。ACE-IS还降低了全因死亡、新发心力衰竭和新发糖尿病的风险。因此，在不能使用ACE-IS的患者中，ARB是降低心血管死亡率和发病率的有价值的选择。(J Am Coll心脏ol 2013；61：131-42)(C)2013，美国心脏病学会基金会
Objectives The goal of the study was to assess the effects of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) on the composite of cardiovascular (CV) death, myocardial infarction (MI), and stroke, and on all-cause death, new-onset heart failure (HF), and new-onset diabetes mellitus (DM) in high-risk patients without HF.Background ACE-Is reduce CV events in high-risk patients without HF whereas the effects of ARBs are less certain.Methods Twenty-six randomized trials comparing ARBs or ACE-Is versus placebo in 108,212 patients without HF were collected in a meta-analysis and analyzed for the risk of the composite outcome, all-cause death, new-onset HF, and new-onset DM.Results ACE-Is significantly reduced the risk of the composite outcome (odds ratio [OR]: 0.830 [95% confidence interval (CI): 0.744 to 0.927]; p = 0.001), MI (OR: 0.811 [95% CI: 0.748 to 0.879]; p < 0.001), stroke (OR: 0.796 [95% CI: 0.682 to 0.928]; p < 0.004), all-cause death (OR: 0.908 [95% CI: 0.845 to 0.975]; p = 0.008), new-onset HF (OR: 0.789 [95% CI: 0.686 to 0.908]; p = 0.001), and new-onset DM (OR: 0.851 [95% CI: 0.749 to 0.965]; p < 0.012). ARBs significantly reduced the risk of the composite outcome (OR: 0.920 [95% CI: 0.869 to 0.975], p = 0.005), stroke (OR: 0.900 [95% CI: 0.830 to 0.977], p = 0.011), and new-onset DM (OR: 0.855 [95% CI: 0.798 to 0.915]; p < 0.001).Conclusions In patients at high CV risk without HF, ACE-Is and ARBs reduced the risk of the composite outcome of CV death, MI, and stroke. ACE-Is also reduced the risk of all-cause death, new-onset HF, and new-onset DM. Thus, ARBs represent a valuable option to reduce CV mortality and morbidity in patients in whom ACE-Is cannot be used. (J Am Coll Cardiol 2013; 61: 131-42) (C) 2013 by the American College of Cardiology Foundation