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Renin-angiotensin-aldosterone system inhibitor use improves clinical outcomes in patients with metabolic

Wee Han Ng1, Yee Hui Yeo2, Hyunseok Kim2

  • 1Bristol Medical School, University of Bristol, Bristol, UK.

Hepatology (Baltimore, Md.)
|April 3, 2025
PubMed
Abstract

Insights

Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers significantly reduced mortality and liver/cardiac events in patients with metabolic dysfunction-associated steatotic liver disease compared to calcium channel blockers.

Area of Science:

  • Cardiovascular Medicine
  • Hepatology
  • Pharmacology

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing health concern.
  • Fibrosis progression in MASLD is a significant clinical challenge.
  • Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) show promise in preclinical models for preventing liver fibrosis.

Purpose of the Study:

  • To evaluate the clinical impact of ACEi/ARB use on patient outcomes.
  • To assess the association between ACEi/ARB and mortality, major adverse liver outcomes, major adverse cardiac events, and incident cancers in MASLD patients.

Main Methods:

  • Retrospective cohort study using the TriNetX nationwide database (2011-2019).
  • Target trial emulation framework with propensity score matching (PSM) to compare ACEi/ARB users with calcium channel blocker (CCB) users.
  • Cox proportional hazards regression analysis for risk assessment over a 10-year follow-up period.

Main Results:

  • ACEi/ARB use was linked to a significant reduction in all-cause mortality (HR: 0.59).
  • Patients on ACEi/ARB showed a decreased risk of major adverse liver outcomes, including ascites and hepatic encephalopathy (HR: 0.70).
  • ACEi/ARB use was associated with a lower risk of major adverse cardiac events (HR: 0.82) but not incident cancer.

Conclusions:

  • ACEi/ARB therapy is associated with improved clinical outcomes in MASLD patients.
  • The findings suggest a potential benefit of ACEi/ARB in reducing mortality and major adverse events in this population.
  • Further prospective studies are recommended for external validation of these findings.
Keywords:
angiotensin receptor blockersangiotensin-converting enzyme inhibitorscancerdecompensationsurvival

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