Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk
Abstract The advantage of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with preserved LV systolic function is uncertain. We aimed to investigate the effects of ACEI/ARB in high atherosclerotic risk patients without overt heart failure (HF) on long...
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| Format: | Article |
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Nature Portfolio
2023-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-50430-8 |
| _version_ | 1797371163195736064 |
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| author | Wanwarang Wongcharoen Nichanan Osataphan Siriluck Gunaparn Suphot Srimahachota Pornwalee Porapakkham Somchai Dutsadeevettakul Arintaya Phrommintikul |
| author_facet | Wanwarang Wongcharoen Nichanan Osataphan Siriluck Gunaparn Suphot Srimahachota Pornwalee Porapakkham Somchai Dutsadeevettakul Arintaya Phrommintikul |
| author_sort | Wanwarang Wongcharoen |
| collection | DOAJ |
| description | Abstract The advantage of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with preserved LV systolic function is uncertain. We aimed to investigate the effects of ACEI/ARB in high atherosclerotic risk patients without overt heart failure (HF) on long-term major cardiovascular outcomes (MACEs). The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. The patients with ejection fraction < 50% were excluded. Among 8513 recruited patients, there were 4246 patients included into final analysis after propensity score matching. At 5-years follow-up, Cox regression analysis showed that ACEI/ARB was significantly associated with reduced risk of all-cause mortality or non-fatal myocardial infarction, non-fatal stroke and HF hospitalization (HR 0.82, 95% CI 0.70–0.96, P = 0.011). The benefit was driven by the reduced all-cause mortality and HF. Subgroup analysis demonstrated that ACEI/ARB decreased risk of long-term MACEs in patients with diabetes (HR 0.77, 95% CI 0.63–0.94, P = 0.011) and patients not taking statin (HR 0.57, 95% CI 0.40–0.82, P = 0.002). We demonstrated that the use of ACEI/ARB was associated with reduced risk of long-term MACEs in a large cohort of high atherosclerotic risk patients. Reduction of all-cause mortality and HF were likely the main contributors to the benefit of ACEI/ARB. |
| first_indexed | 2024-03-08T18:15:51Z |
| format | Article |
| id | doaj.art-af7978539a9745c68124771e798881ed |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-08T18:15:51Z |
| publishDate | 2023-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-af7978539a9745c68124771e798881ed2023-12-31T12:11:02ZengNature PortfolioScientific Reports2045-23222023-12-011311810.1038/s41598-023-50430-8Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular riskWanwarang Wongcharoen0Nichanan Osataphan1Siriluck Gunaparn2Suphot Srimahachota3Pornwalee Porapakkham4Somchai Dutsadeevettakul5Arintaya Phrommintikul6Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDepartment of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDepartment of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDepartment of Internal Medicine, Faculty of Medicine, Chulalongkorn UniversityCentral Chest Institute of ThailandDepartment of Medicine, Golden Jubilee Medical Center, Mahidol UniversityDepartment of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityAbstract The advantage of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with preserved LV systolic function is uncertain. We aimed to investigate the effects of ACEI/ARB in high atherosclerotic risk patients without overt heart failure (HF) on long-term major cardiovascular outcomes (MACEs). The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. The patients with ejection fraction < 50% were excluded. Among 8513 recruited patients, there were 4246 patients included into final analysis after propensity score matching. At 5-years follow-up, Cox regression analysis showed that ACEI/ARB was significantly associated with reduced risk of all-cause mortality or non-fatal myocardial infarction, non-fatal stroke and HF hospitalization (HR 0.82, 95% CI 0.70–0.96, P = 0.011). The benefit was driven by the reduced all-cause mortality and HF. Subgroup analysis demonstrated that ACEI/ARB decreased risk of long-term MACEs in patients with diabetes (HR 0.77, 95% CI 0.63–0.94, P = 0.011) and patients not taking statin (HR 0.57, 95% CI 0.40–0.82, P = 0.002). We demonstrated that the use of ACEI/ARB was associated with reduced risk of long-term MACEs in a large cohort of high atherosclerotic risk patients. Reduction of all-cause mortality and HF were likely the main contributors to the benefit of ACEI/ARB.https://doi.org/10.1038/s41598-023-50430-8 |
| spellingShingle | Wanwarang Wongcharoen Nichanan Osataphan Siriluck Gunaparn Suphot Srimahachota Pornwalee Porapakkham Somchai Dutsadeevettakul Arintaya Phrommintikul Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk Scientific Reports |
| title | Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| title_full | Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| title_fullStr | Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| title_full_unstemmed | Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| title_short | Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| title_sort | effect of renin angiotensin system inhibitors on long term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk |
| url | https://doi.org/10.1038/s41598-023-50430-8 |
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