https://diabetes.acponline.org/archives/2014/05/09/1.htm

ACE inhibitors improved all-cause mortality, cardiovascular outcomes versus ARBs

Angiotensin-converting enzyme (ACE) inhibitors improved all-cause mortality, cardiovascular mortality, and major cardiovascular events compared with angiotensin II receptor blockers (ARBs) in patients with diabetes, a new study found.


Angiotensin-converting enzyme (ACE) inhibitors improved all-cause mortality, cardiovascular mortality, and major cardiovascular events compared with angiotensin II receptor blockers (ARBs) in patients with diabetes, a new study found.

Researchers performed a meta-analysis to examine how ACE inhibitors and ARBs affect all-cause mortality, cardiovascular deaths, and major cardiovascular events in diabetic patients. Randomized clinical trials that were published between 1966 and 2012, reported the effects of both classes of drugs on these outcomes, and had an observation period of 12 months or longer were included.

The researchers analyzed dichotomous outcomes data from individual trials by using risk ratios (RRs) and 95% CIs and random-effects models, and differences between subgroup estimates were calculated with tests for interactions. Heterogeneity was identified via meta-regression analyses. The study's primary end points were all-cause and cardiovascular mortality, while secondary end points were effects of both drug classes on cardiovascular events. The study results were published online March 31 and in the May issue of JAMA Internal Medicine.

Of the trials identified and included in the study, 23 compared ACE inhibitors with control therapy (n=32,827 patients) and 13 compared ARBs with control therapy (n=23,867 patients). ACE inhibitors reduced all-cause mortality by 13% (20 trials; RR, 0.87; 95% CI, 0.78 to 0.98), cardiovascular deaths by 17% (13 trials; RR, 0.83; 95% CI, 0.70 to 0.99), and major cardiovascular events by 14% (14 trials; RR, 0.86; 95% CI, 0.77 to 0.95) compared with control therapy. ARBs, in contrast, did not appear to significantly affect any of the study end points besides heart failure events (4 trials; RR, 0.70; 95% CI, 0.59 to 0.82). Neither class of drugs appeared to reduce stroke risk in diabetics.

The authors noted that their study compared ACE inhibitors and ARBs only indirectly, that the populations of the included studies varied significantly, and that the trials examining each class of drug were not equivalent. However, they concluded that ACE inhibitors decrease all-cause mortality, cardiovascular mortality, and major cardiovascular events in patients with diabetes while ARBs appear to have no similar effects. Based on their findings, they concluded, “ACE [inhibitors] should be considered as first-line therapy to limit the excess mortality and morbidity in this population.”