Azmil H Abdul-Rahim1, Kieran F Docherty2, Hicham Skali3, Lars Køber4, Kenneth Dickstein5, Aldo P Maggioni6, Viacheslav Mareev7, Faiez Zannad8, Eric J Velazquez9, Robert M Califf9,10, Marc A Pfeffer3, Scott D Solomon3, Kennedy R Lees1, John Jv McMurray1. 1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 2. Department of Cardiology, Western Infirmary, Glasgow, Scotland, UK. 3. Brigham & Women's Hospital, Boston, MA, USA. 4. Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 5. Stavanger University Hospital, Stavanger, Bergen, Norway. 6. ANMCO Research Center, Florence, Italy. 7. University Clinic M.V.Lomonosov Moscow State University, Moscow, Russia. 8. Clinical Investigation Center 1493, INSERM, Nancy, France. 9. Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 10. Duke Translational Medicine Institute, Durham, NC, USA.
Abstract
INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction. PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group. RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08). CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.
INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction. PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group. RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08). CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.
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