Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis

M. Adnan Nadir; Li Wei; Douglas H. J. Elder; Renata Libianto; Tiong K. Lim; Maheshwar Pauriah; Stuart D. Pringle; Alex D. Doney; Anna-Maria Choy; Allan D. Struthers; Chim C. Lang

doi:10.1016/j.jacc.2011.01.063

Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis

M. Adnan Nadir, Li Wei, Douglas H. J. Elder, Renata Libianto, Tiong K. Lim, Maheshwar Pauriah, Stuart D. Pringle, Alex D. Doney, Anna-Maria Choy, Allan D. Struthers, Chim C. Lang (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

139 Citations (Scopus)

Abstract

Objectives The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).

Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.

Methods The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (> 110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).

Results A total of 2,117 patients with AS (mean age 73 +/- 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.

Conclusions This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS. (J Am Coll Cardiol 2011;58:570-6) (C) 2011 by the American College of Cardiology Foundation

Original language	English
Pages (from-to)	570-576
Number of pages	7
Journal	Journal of the American College of Cardiology
Volume	58
Issue number	6
DOIs	https://doi.org/10.1016/j.jacc.2011.01.063
Publication status	Published - 2 Aug 2011

Keywords

Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Aortic stenosis
Converting enzyme inhibitors
Pressure overload hypertrophy
Left ventricular hypertrophy
Normal coronary arteries
Valve disease
Heart failure
Diastolic disfunction
Delay progression
Replacement
Angina

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10.1016/j.jacc.2011.01.063

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@article{1ef09ed652b44974b2882f625e0de9d3,

title = "Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis",

abstract = "Objectives The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.Methods The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (> 110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).Results A total of 2,117 patients with AS (mean age 73 +/- 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.Conclusions This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS. (J Am Coll Cardiol 2011;58:570-6) (C) 2011 by the American College of Cardiology Foundation",

keywords = "Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Aortic stenosis, Converting enzyme inhibitors, Pressure overload hypertrophy, Left ventricular hypertrophy, Normal coronary arteries, Valve disease, Heart failure, Diastolic disfunction, Delay progression, Replacement, Angina",

author = "Nadir, {M. Adnan} and Li Wei and Elder, {Douglas H. J.} and Renata Libianto and Lim, {Tiong K.} and Maheshwar Pauriah and Pringle, {Stuart D.} and Doney, {Alex D.} and Anna-Maria Choy and Struthers, {Allan D.} and Lang, {Chim C.}",

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doi = "10.1016/j.jacc.2011.01.063",

language = "English",

volume = "58",

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T1 - Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis

AU - Nadir, M. Adnan

AU - Wei, Li

AU - Elder, Douglas H. J.

AU - Libianto, Renata

AU - Lim, Tiong K.

AU - Pauriah, Maheshwar

AU - Pringle, Stuart D.

AU - Doney, Alex D.

AU - Choy, Anna-Maria

AU - Struthers, Allan D.

AU - Lang, Chim C.

PY - 2011/8/2

Y1 - 2011/8/2

N2 - Objectives The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.Methods The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (> 110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).Results A total of 2,117 patients with AS (mean age 73 +/- 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.Conclusions This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS. (J Am Coll Cardiol 2011;58:570-6) (C) 2011 by the American College of Cardiology Foundation

AB - Objectives The purpose of this study was to investigate the impact of renin-angiotensin system blockade therapy on outcomes in aortic stenosis (AS).Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are perceived to be relatively contraindicated in AS. However, inhibitors of the renin-angiotensin system may be beneficial in AS through their cardioprotective and beneficial effects on left ventricular remodeling.Methods The Health Informatics dispensed prescribing, morbidity, and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database (> 110,000 scans). Patients with a diagnosis of AS from 1993 to 2008 were identified. Cox regression model (adjusted for confounding variables) and propensity score analysis were used to assess the impact of ACEIs or ARBs on all-cause mortality and cardiovascular (CV) events (CV death or hospitalizations).Results A total of 2,117 patients with AS (mean age 73 +/- 12 years, 46% men) were identified and 699 (33%) were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, there were 1,087 (51%) all-cause deaths and 1,018 (48%) CV events. Those treated with ACEIs or ARBs had a significantly lower all-cause mortality with an adjusted hazard ratio of 0.76 (95% confidence interval: 0.62 to 0.92, p < 0.0001) and fewer CV events with an adjusted hazard ratio of 0.77 (95% confidence interval: 0.65 to 0.92, p < 0.0001). The outcome benefits of ACEIs/ARBs were further supported by propensity score analysis.Conclusions This large observational study suggests that ACEI/ARB therapy is associated with an improved survival and a lower risk of CV events in patients with AS. (J Am Coll Cardiol 2011;58:570-6) (C) 2011 by the American College of Cardiology Foundation

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KW - Angiotensin receptor blockers

KW - Aortic stenosis

KW - Converting enzyme inhibitors

KW - Pressure overload hypertrophy

KW - Left ventricular hypertrophy

KW - Normal coronary arteries

KW - Valve disease

KW - Heart failure

KW - Diastolic disfunction

KW - Delay progression

KW - Replacement

KW - Angina

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DO - 10.1016/j.jacc.2011.01.063

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

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ER -

Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis

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