Angiotensin II receptor blockers versus angiotensin-converting enzyme inhibitors in patients with stable coronary artery disease: Prevalence, correlates, and prognostic impact (from the CORONOR study).
In international guidelines for patients with stable coronary artery disease (CAD), angiotensin-converting enzyme inhibitors (ACE-I) are recommended while angiotensin II receptor blockers (ARB) are proposed as an alternative in case of intolerance. There are no real-life data on the frequency and correlates of ARB use in this setting.



We studied 3363 outpatients included in a prospective registry on stable CAD (the CORONOR study) and receiving an ARB or an ACE-I at inclusion.



Altogether, 944 patients received an ARB (28.1%). Factors positively and independently associated with ARB use versus ACE-I use were a history of hypertension, the absence of prior myocardial infarction, age, female gender, estimated glomerular filtration rate <60ml/min/m2, and left ventricular ejection fraction ≥40%. In the whole study population, the hazard ratio (HR) for the combined endpoint (cardiovascular death, myocardial infarction, stroke) of patients with ARB use was 0.95 (0.69-1.31) (p=0.765) (patients with ACE-I use as reference). Similar results were observed when the analysis was restricted to a propensity-matched cohort: HR=0.91 (0.62-1.34) (p=0.632).



Our study shows that a significant proportion of stable CAD patients are treated with ARB rather than with ACE-I in modern practice. Several correlates of ARB prescription were identified. Our results suggest that patients receiving ARB have similar outcome than patients receiving ACE-I.
Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France.
Gilles
G
Lemesle
Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France.
Nicolas
N
Lamblin
Polyclinique du Bois, Lille, France.
Thibaud
T
Meurice
Centre Hospitalier de Dunkerque, Dunkerque, France.
Olivier
O
Tricot
Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Faculté de Médecine de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France. Electronic address: christophe.bauters@chru-lille.fr.
Christophe
C
Bauters
D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
Angiotensin; Coronary artery disease; Secondary prevention