Karl Emil Kristensen1, Christian Torp-Pedersen2, Gunnar Hilmar Gislason2, Martin Egfjord2, Henrik Berg Rasmussen2, Peter Riis Hansen2. 1. 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. 2. 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.).
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. APPROACH AND 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.
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. 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: Johannes Stegbauer; Sean E Thatcher; Guang Yang; Katharina Bottermann; Lars Christian Rump; Alan Daugherty; Lisa A Cassis Journal: J Vasc Surg Date: 2019-03-06 Impact factor: 4.268
Authors: Kana Fujikura; Alessandra Albini; R Graham Barr; Megha Parikh; Julia Kern; Eric Hoffman; Grant T Hiura; David A Bluemke; James Carr; João A C Lima; Erin D Michos; Antoinette S Gomes; Martin R Prince Journal: Int J Cardiol Date: 2021-02-13 Impact factor: 4.164
Authors: Albert Busch; Martin Busch; Claus-Jürgen Scholz; Richard Kellersmann; Christoph Otto; Ekaterina Chernogubova; Lars Maegdefessel; Alma Zernecke; Udo Lorenz Journal: Int J Mol Sci Date: 2016-01-12 Impact factor: 5.923