Angiotensin II receptor blockers and myocardial infarction: deeds and misdeeds

A recent editorial published by Verma and Strauss, entitled 'Angiotensin receptor blockers and myocardial infarction', examined, through a partial analysis of individual trials, the use of angiotensin receptor blockers (ARBs) in a variety of clinical settings. This editorial was reported widely in the lay press and media, and generated disappointment and concern among physicians in many countries, probably because of its provocative subtitle in the British Medical Journal: 'These drugs may increase myocardial infarction and patients may need to be told'.

In order to explore the influence of ARBs on myocardial infarction, we performed a more comprehensive and updated meta-analysis, taking into account all major international, randomized trials using ARBs compared with another active drug or conventional therapy (placebo), and reporting information on rates of myocardial infarction.

We found no significant differences in fatal and non-fatal myocardial infarction between treatment with ARBs, placebo or active treatment, and the same result was obtained when considering only trials in which ARBs were compared with angiotensin-converting enzyme inhibitors (ACEIs), or when pooling all trials together. The pooled analysis of these trials shows that the relative risk of myocardial infarction lies substantially on the indifference line.

Our analysis demonstrates that, at this time, there is no evidence of increased risk of myocardial infarction in patients treated with ARBs.