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Angiotensin Receptor Blockers Decrease the Risk of Major Adverse Cardiovascular Events in Patients with End-Stage
Chung-Wei Yang1, Nian-Sheng Tzeng2, Yun-Ju Yin3
1Division of Nephrology, Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
Insights
Angiotensin receptor blockers (ARBs) significantly reduce major adverse cardiovascular events (MACE) in patients with end-stage renal disease (ESRD) on dialysis. Long-term ARB use is associated with lower MACE incidence, especially in those with comorbidities.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Background:
- Major adverse cardiovascular events (MACE) are the leading cause of death in end-stage renal disease (ESRD) patients undergoing dialysis.
- Angiotensin receptor blockers (ARBs) are known to reduce MACE in non-dialysis patients.
- The efficacy of ARBs in ESRD patients on dialysis remains to be fully elucidated.
Purpose of the Study:
- To investigate the effect of ARBs on MACE risk in patients with ESRD on maintenance dialysis.
- To determine if ARBs therapy can attenuate cardiovascular risk in this specific patient population.
Main Methods:
- A cohort of 1800 ESRD patients on dialysis without prior MACE or ARB use was analyzed.
- Cox proportional hazard regression was employed to identify risk factors and calculate hazard ratios.
- Data was sourced from a national health research institute database of one million subjects.
Main Results:
- ARBs significantly decreased the incidence of acute myocardial infarction (AMI), coronary artery disease (CAD), peripheral artery disease (PAD), and acute stroke.
- Cumulative ARB prescription exceeding 365-760 days showed a negative correlation with MACE incidence.
- For patients with diabetes and hyperlipidemia, 91-365 days of ARB use may reduce risk.
Conclusions:
- ARBs significantly attenuate the risk of MACE, including AMI, acute stroke, and PAD requiring intervention, in dialysis patients.
- Longer duration of ARB therapy is associated with greater cardiovascular risk reduction in this population.
Background:
Major adverse cardiovascular events (MACE) cause the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD) on maintenance Hemodialysis (HD) or peritoneal dialysis (PD). Many randomized-controlled trials (RCTs) have proved that angiotensin receptor blockers (ARBs) can reduce the risk of MACE in the people with normal or impaired kidney function without dialysis. This study seeks to clarify whether ARBs therapy could also attenuate this risk in patients with ESRD on maintenance dialysis.
Materials And Methods:
The National Health Research Institute provided a database of one million random subjects for the study. A random sample was taken of 1800 patients ≥18 years y/o with ESRD on dialysis without a history of MACE and use of ARBs within 6-months prior to enrollment. Cox proportional hazard regression analysis was used to identify the risk factors and compute the hazard ratios accompanying 95% confidence intervals.
Results:
In these 1800 patients, 1061 had never used ARBs, while 224 had used them for 1-90 days, and 515 had used them for more than 90 days. We found that ARBs significantly decrease the incidences of acute myocardial infarctions (AMI), coronary artery diseases (CAD) requiring coronary stent or percutaneous transluminal coronary angioplasty (PTCA), peripheral artery disease (PAD) requiring percutaneous transluminal angioplasty (PTA), and acute stroke. Cumulative prescription days of ARBs beyond 365-760 days or more were found to be negatively correlated with incidence of MACEs. For patients with dual comorbidity (i.e., mellitus and hyperlipidemia), 91-365 cumulative prescription days might also attenuate the risk.
Conclusions:
For patients on maintenance dialysis, the use of ARBs could significantly attenuate the risk of major cardiovascular events: AMI, acute stroke, and PAD requiring PTA.
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