Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with abdominal aortic aneurysms: nation-wide cohort study

TY - JOUR

T1 - Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with abdominal aortic aneurysms

T2 - nation-wide cohort study

AU - Kristensen, Karl Emil

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar Hilmar

AU - Egfjord, Martin

AU - Rasmussen, Henrik Berg

AU - Hansen, Peter Riis

N1 - © 2015 American Heart Association, Inc.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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. Approach and Results-All patients diagnosed with AAA during the period 1995 to 2011 were identified from the Danish nation-wide registries. Infjects 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.

AB - 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. Approach and Results-All patients diagnosed with AAA during the period 1995 to 2011 were identified from the Danish nation-wide registries. Infjects 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.

KW - Aged

KW - Aged, 80 and over

KW - Angiotensin II Type 1 Receptor Blockers

KW - Angiotensin-Converting Enzyme Inhibitors

KW - Aortic Aneurysm, Abdominal

KW - Chi-Square Distribution

KW - Denmark

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Registries

KW - Renin-Angiotensin System

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Surgical Procedures

U2 - 10.1161/ATVBAHA.114.304428

DO - 10.1161/ATVBAHA.114.304428

M3 - Journal article

C2 - 25633315

SN - 1079-5642

VL - 35

SP - 733

EP - 740

JO - Arteriosclerosis, Thrombosis, and Vascular Biology

JF - Arteriosclerosis, Thrombosis, and Vascular Biology

IS - 3

ER -