ACEIs, Not ARBs, Reduce Cardiac Mortality in Diabetes
(HealthDay News) — For patients with diabetes mellitus (DM), angiotensin-converting enzyme inhibitors (ACEIs), but not angiotensin II receptor blockers (ARBs), reduce all-cause and cardiovascular (CV) mortality, according to research published online March 31 in JAMA Internal Medicine.
Jun Cheng, MD, from the First Affiliated Hospital Medical School of Zhejiang University in Hangzhou, China, and colleagues conducted a meta-analysis to assess the effects of ACEIs and ARBs on all-cause mortality, CV deaths, and major CV events in patients with DM. Twenty-three trials compared ACEI with placebo or active drugs in 32,827 patients, while 13 trials compared ARBs with no therapy in 23,867 patients.
The researchers found that ACEIs correlated with a significant reduction in the risk of all-cause mortality, CV deaths, and major CV events (risk ratios [RRs], 0.87, 0.83, and 0.86, respectively), including myocardial infarction and heart failure (RRs, 0.79 and 0.81, respectively), compared with placebo/active treatment. ARB treatment did not significantly affect all-cause mortality (RR, 0.94; 95 percent confidence interval [CI], 0.82 to 1.08), CV death rate (1.21; 95% CI, 0.81–1.80), and major CV events (RR, 0.94; 95% CI, 0.85–1.01). ARB treatment was significantly tied to reduction in heart failure (RR, 0.70). In patients with DM, ACEIs and ARBs were not associated with a reduction in the risk of stroke. The impact of ACEI treatment on all-cause mortality and CV death did not vary with starting baseline blood pressure and proteinuria, or with the type of ACEI and DM.
"ACEIs should be considered as first-line therapy to limit excess mortality and morbidity in this population," the authors write.