TY - JOUR
T1 - The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation
T2 - a large population cohort study
AU - Elder, Douglas H. J.
AU - Wei, Li
AU - Szwejkowski, Benjamin R.
AU - Libianto, Renata
AU - Nadir, Adnan
AU - Pauriah, Maheshwar
AU - Rekhraj, Sushma
AU - Lim, Tiong K.
AU - George, Jacob
AU - Doney, Alex
AU - Pringle, Stuart D.
AU - Choy, Anna-Maria
AU - Struthers, Allan D.
AU - Lang, Chim C.
N1 - Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - Objectives The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).Background Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.Methods The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).Results A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 +/- 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p < 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p < 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p < 0.01) for AR events.Conclusions This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial. (J Am Coll Cardiol 2011;58:2084-91) (C) 2011 by the American College of Cardiology Foundation
AB - Objectives The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).Background Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.Methods The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).Results A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 +/- 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p < 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p < 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p < 0.01) for AR events.Conclusions This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial. (J Am Coll Cardiol 2011;58:2084-91) (C) 2011 by the American College of Cardiology Foundation
KW - Angiotensin-converting enzyme inhibitors
KW - Angiotensin receptor blockers
KW - Aortic regurgitation
KW - Converting enzyme inhibitor
KW - Term vasodilator therapy
KW - Chronic volume overload
KW - Asymptomatic patients
KW - Mitral regurgitation
KW - Myocardial infarction
KW - Valve regurgitation
KW - Left ventricle
KW - Insufficiecy
KW - Nifedipine
U2 - 10.1016/j.jacc.2011.07.043
DO - 10.1016/j.jacc.2011.07.043
M3 - Article
C2 - 22051330
SN - 0735-1097
VL - 58
SP - 2084
EP - 2091
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -