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Cardiovascular outcomes in high-risk patients without heart failure treated with ARBs: a systematic review and

Mohamad M Al Khalaf1, Lukman Thalib, Suhail A R Doi

  • 1Department of Medicine, Kuwait University, Safat, Kuwait.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|January 31, 2009
PubMed

Insights

Angiotensin II type 1 receptor antagonists (ARBs) do not offer cardiovascular protection comparable to angiotensin-converting enzyme inhibitors (ACEIs) in patients without heart failure. Caution is advised when using ARBs as an ACEI substitute, as they may increase myocardial infarction risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Angiotensin II type 1 receptor antagonists (ARBs) are frequently prescribed as alternatives to angiotensin-converting enzyme inhibitors (ACEIs) for patients without heart failure.
  • The comparative efficacy of ARBs versus ACEIs regarding cardiovascular morbidity and mortality in this patient population remains uncertain.

Purpose of the Study:

  • To systematically review and meta-analyze the impact of ARBs on cardiovascular outcomes in high-risk patients without heart failure.
  • To compare the effectiveness of ARBs against control groups in preventing myocardial infarction, stroke, cardiovascular death, and all-cause death.

Main Methods:

  • A comprehensive literature search was conducted across major databases (PubMed, CENTRAL, MEDLINE, EMBASE) from 1990 to 2008.
  • Included were 37 randomized controlled trials involving over 89,000 patients, comparing ARBs to non-ARB control groups.
  • Data on myocardial infarction, stroke, cardiovascular death, and all-cause death were extracted and analyzed.

Main Results:

  • ARBs showed a statistically significant increase in the odds of myocardial infarction (OR 1.09, p=0.05) compared to controls in the subgroup without heart failure.
  • No statistically significant differences were observed for cardiovascular death or all-cause death.
  • A trend towards fewer strokes in the ARB group was noted, but heterogeneity precluded pooled analysis.

Conclusions:

  • Current evidence does not support ARBs as conferring cardiovascular protection similar to ACEIs in non-heart failure patients.
  • The use of ARBs as a substitute for ACEIs in patients tolerant of ACEIs, without a heart failure indication, should be approached with caution.
  • While a potential stroke benefit exists, its quantification is limited by study heterogeneity.
Abstract

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