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Receptor Autoradiography Protocol for the Localized Visualization of Angiotensin II Receptors
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Angiotensin receptor blockers and risk of myocardial infarction: systematic review

Michael A McDonald1, Scot H Simpson, Justin A Ezekowitz

  • 1Division of Cardiology, University of Alberta, 2C2 WMC, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7.

BMJ (Clinical Research Ed.)
|September 27, 2005
PubMed
Abstract

Insights

Angiotensin receptor blockers (ARBs) do not increase the risk of myocardial infarction in high-risk patients. This systematic review found no significant increase in heart attack risk compared to placebo or ACE inhibitors.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Cardiovascular disease remains a leading cause of mortality worldwide.
  • Angiotensin receptor blockers (ARBs) are a class of drugs used to treat hypertension and heart failure.
  • Concerns have been raised regarding the potential cardiovascular safety of ARBs, specifically their effect on myocardial infarction (MI).

Purpose of the Study:

  • To systematically evaluate the risk of myocardial infarction (MI) associated with the use of angiotensin receptor blockers (ARBs).
  • To compare the risk of MI between ARBs and placebo.
  • To compare the risk of MI between ARBs and angiotensin-converting enzyme (ACE) inhibitors.

Main Methods:

  • A systematic review and meta-analysis of controlled clinical trials.
  • Searches of major databases including Medline, Embase, and the Cochrane central register of controlled trials.
  • Inclusion of 19 studies with 31,569 patients, comparing ARBs with placebo or ACE inhibitors in patients at risk for cardiovascular events.

Main Results:

  • Across 11 studies (21,062 patients), ARBs were not associated with an increased risk of MI compared to placebo (OR 0.94, 95% CI 0.75-1.16).
  • In nine studies (10,625 patients), ARBs did not show an increased risk of MI compared to ACE inhibitors (OR 1.01, 95% CI 0.87-1.16).
  • The confidence intervals did not exclude a potential increase of up to 16% or a reduction of up to 25% in MI risk.

Conclusions:

  • Treatment with angiotensin receptor blockers is not significantly associated with an increased risk of myocardial infarction.
  • While current findings alleviate safety concerns, larger prospective trials are needed for definitive conclusions.
  • The results suggest ARBs can be safely used in patients at risk for cardiovascular events, pending further evidence.

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