title: Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure.
abstract: BACKGROUND
  Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.
  
  
  METHODS
  Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.
  
  
  RESULTS
  During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.
  
  
  CONCLUSIONS
  These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. Electronic address: htr@ssi.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Svanström
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Björn
authors.initials: B
authors.lastname: Pasternak
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Melbye
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Hviid
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death / Q000639:trends; D003718:Denmark / Q000453:epidemiology; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin converting enzyme-inhibitors; Comparative effectiveness; Heart failure; Mortality