title: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with abdominal aortic aneurysms: nation-wide cohort study.
abstract: OBJECTIVE
  The renin-angiotensin system is thought to play a pivotal role in the pathogenesis of abdominal aortic aneurysms (AAAs). However, effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) on human AAAs remain unclear. We therefore examined whether treatment with ACEIs or ARBs influenced hard clinical end points in a nation-wide cohort of patients with AAA.
  
  
  RESULTS
  All patients diagnosed with AAA during the period 1995 to 2011 were identified from the Danish nation-wide registries. Subjects were divided according to ACEI and ARB treatment status and followed up for an average of 5 years. Study outcomes were evaluated by time-dependent Cox proportional hazard models. Of 9441 patients with AAA, 12.6% were treated with ACEIs and 5.0% received ARBs. Incidence rates of death from AAA per 100 patient-years were 3.7, 3.6, 4.0, and 4.7 for treatment with ACEIs or ARBs, ACEIs, ARBs, and no ACEI/ARB, respectively. Hazard ratios of death from AAA were 0.64 (95% confidence interval, 0.51-0.80; P<0.001) for patients receiving ACEIs and 0.65 (95% confidence interval, 0.48-0.88; P=0.006) for those receiving ARBs, respectively (P for difference=0.944). The risk of surgery for AAA was significantly reduced in patients receiving ACEIs (hazard ratio, 0.86 [95% confidence interval, 0.74-0.99]; P=0.040) but not in patients receiving ARBs (hazard ratio, 1.02 [95% confidence interval, 0.84-1.23]; P=0.867; P for difference=0.119).
  
  
  CONCLUSIONS
  In this observational study, treatment with ACEIs or ARBs was associated with a comparable reduction in mortality but not in surgery for AAA among patients with AAA. Randomized controlled trials are warranted to confirm these findings.
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.). karl.emil.kristensen@regionh.dk.
authors: Karl Emil
authors: KE
authors: Kristensen
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.).
authors: Christian
authors: C
authors: Torp-Pedersen
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.).
authors: Gunnar Hilmar
authors: GH
authors: Gislason
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.).
authors: Martin
authors: M
authors: Egfjord
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.).
authors: Henrik Berg
authors: HB
authors: Rasmussen
authors: From the Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark (K.E.K., G.H.G., P.R.H.); Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.); Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (M.E.); and Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark (H.B.R.).
authors: Peter Riis
authors: PR
authors: Hansen
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*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: aneurysm; cardiovascular diseases; hypertension; pharmacoepidemiology; renin-angiotensin system