title: Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients.
abstract: BACKGROUND
  Frail and polypathological patients (PP) are often undertreated with evidence-based cardiovascular drugs, as their benefits are uncertain in this population.
  
  
  OBJECTIVE
  To determine the effects of treatment with renin-angiotensin system blockers/inhibitors (ACEI/ARB), statins and/or beta-blockers on survival rates and functional decline in PP with evidence-based clinical indications for treatment with any of these drug families.
  
  
  METHODS
  Prospective observational multicentre cohort study with a 12-month follow-up period. We selected PP with any condition of the following: chronic heart failure, coronary heart disease, chronic renal disease, cerebrovascular disease, peripheral artery disease, diabetes mellitus with any visceral involvement, hypertension, and dyslipidaemia. Clinical, functional (Barthel index), socio-familial risk data and drug prescriptions were measured at baseline. Multivariate Cox proportional hazards and logistic regression models were used to identify variables independently associated with survival and functional decline.
  
  
  RESULTS
  The analysis included 1260 PP. The mean age was 79±9.5 years. The mortality rate was 34.5%. Statin (aHR 0.671; P=0.001), beta-blocker plus statin (aHR 0.645; P=0.007), ACEI/ARB plus statin (aHR 0.680; P=0.002), or combined ACEI/ARB plus statin plus beta-blocker (aHR 0.541; P=0.000) prescriptions were associated with longer survival times. Additionally, PP whose Barthel index was ≥60 showed a lower risk of disability progression if treated with statins (aOR=0.476; P=0.000), or their combinations, mainly with ACEI/ARB plus beta-blockers (aOR 0.563; P=0.031).
  
  
  CONCLUSIONS
  The prescription of statins, alone or in combination with other drugs, may impact the survival and functional decline in polypathological patients. Further prospective blinded randomised assays are needed to confirm these observations.
authors.affiliation: Hospital Universitario Virgen del Rocío, Seville, Spain. galinx3@gmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Galindo-Ocaña
authors.forename: Máximo
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.forename: Aurelio
authors.initials: A
authors.lastname: Fuertes-Martín
authors.forename: Bosco
authors.initials: B
authors.lastname: Barón-Franco
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Murcia-Zaragoza
authors.forename: Lourdes
authors.initials: L
authors.lastname: Moreno-Gaviño
authors.forename: Manuel
authors.initials: M
authors.lastname: Ollero-Baturone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors