title: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high vascular risk.
abstract: ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely prescribed in patients with high cardiovascular (CV) risk. However, whether both classes have equivalent effectiveness to prevent CV events remains unclear. The aim of this study was to compare the incidence of major CV events between ACEI and ARB users.
  
  
  
  The Reduction of Atherothrombosis for Continued Health registry is an observational study who enrolled 69 055 individuals with high CV risk. Among them, 40 625 patients (ACEIs 67.9% and ARBs 32.1%) were included. Main outcome was rates of CV mortality, non-fatal myocardial infarction, non-fatal stroke or hospitalisation for CV disease at 4 years.
  
  
  
  In a propensity score-adjusted cohort, the incidence of the primary outcome was lower in patients on ARBs compared with ACEIs (29.2% vs 33.4%; adjusted HR 0.90; 95% CI 0.86 to 0.95; p<0.001). Similar results were observed for CV (6.9% vs 8.2%; HR 0.83; 95% CI 0.75 to 0.93; p=0.001) and all-cause mortality (11.6% vs 12.6%; HR 0.89; 95% CI 0.82 to 0.97; p=0.005). Analyses using propensity score matching yielded similar results. History of diabetes or estimated glomerular filtration rate did not affect the results. ARB use was associated with lower rates of all-cause mortality in secondary prevention but not in primary prevention patients (p-value for interaction=0.03).
  
  
  
  ARB use appears to be associated with 10% lower rates of CV events compared with ACEIs, especially in patients with established CV disease. Our results suggest that ARBs may provide superior protection against CV events than ACEIs in high-risk patients in real-world practice.
authors.affiliation: Département d'Endocrinologie, Diabétologie et Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.|Université Paris Diderot-Sorbonne Paris Cité, Paris, France.|Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Potier
authors.affiliation: Département d'Endocrinologie, Diabétologie et Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.|Université Paris Diderot-Sorbonne Paris Cité, Paris, France.|Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Roussel
authors.affiliation: FACT DHU FIRE, LVTS INSERM U-1148, Hôpital Bichat, HUPNVS, AP-HP, Paris, France.
authors.forename: Yedid
authors.initials: Y
authors.lastname: Elbez
authors.affiliation: Département d'Endocrinologie, Diabétologie et Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.|Université Paris Diderot-Sorbonne Paris Cité, Paris, France.|Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Marre
authors.affiliation: Klinikum Ludwigshafen und Institut für Herzinfarktforschung, Ludwigshafen, Rhineland-Palatinate, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, School of Public Health, Curtin University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Perth, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Magnus
authors.initials: M
authors.lastname: Ohman
authors.affiliation: Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Université Paris Diderot-Sorbonne Paris Cité, Paris, France.|FACT DHU FIRE, LVTS INSERM U-1148, Hôpital Bichat, HUPNVS, AP-HP, Paris, France.|NHLI Imperial College, Royal Brompton Hospital, London, UK.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Cardiac risk factors and prevention; Coronary artery disease; Epidemiology