title: Renin-angiotensin system antagonists and clinical outcomes in stable coronary artery disease without heart failure.
abstract: OBJECTIVE
  The aim of this study was to determine whether angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) use is associated with lower rates of cardiovascular events in patients with stable coronary artery disease (CAD) but without heart failure (HF) receiving contemporary medical management.
  
  
  RESULTS
  Using data from the Reduction of Atherothrombosis for Continued Health (REACH) registry, we examined, using propensity score approaches, relationships between cardiovascular outcomes and ACEI/ARB use (64.1% users) in 20 909 outpatients with stable CAD and free of HF at baseline. As internal control, we assessed the relation between statin use and outcomes. At 4-year follow-up, the risk of cardiovascular death, MI, or stroke (primary outcome) was similar in ACEI/ARB users compared with non-users (hazard ratio, 1.03; 95% confidence interval [CI], 0.91-1.16; P = 0.66). Similarly, the risk of the primary outcome and cardiovascular hospitalization for atherothrombotic events (secondary outcome) was not reduced in ACEI/ARB users (hazard ratio, 1.08; 95% CI, 1.01-1.16; P = 0.04), nor were the rates of any of its components. Analyses using propensity score matching yielded similar results, as did sensitivity analyses accounting for missing covariates, changes in medications over time, or analysing separately ACEI and ARB use. In contrast, in the same cohort, statin use was associated with lower rates for all outcomes.
  
  
  CONCLUSIONS
  Use of ACEI/ARB was not associated with better outcomes in stable CAD outpatients without HF. The benefit of ACEI/ARB seen in randomized clinical trials was not replicated in this large contemporary cohort, which questions their value in this specific subset.
authors.affiliation: Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France Hôpital Avicenne, AP-HP, Bobigny, France Université Paris XIII, Bobigny, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.affiliation: Inserm U-1148, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: Inserm U-1148, Paris, France Université Pierre et Marie Curie, Paris, France Hôpital Saint-Antoine, AP-HP, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Hôpital Bichat, AP-HP, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Delorme
authors.affiliation: Université Paris-Descartes, Paris, France Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.affiliation: Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.affiliation: Hôpital Avicenne, AP-HP, Bobigny, France Université Paris XIII, Bobigny, France Université Paris-Descartes, Paris, France Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
authors.affiliation: University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Département Hospitalo-Universitaire FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France Inserm U-1148, Paris, France Hôpital Bichat, AP-HP, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK gabriel.steg@bch.aphp.fr.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Angiotensin-II receptor blockers; Angiotensin-converting enzyme inhibitors; Stable coronary artery disease; Statins