The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with a reduced risk of myocardial infarction (MI) among patients with rheumatoid arthritis (RA), according to a nationwide cohort study published in PLOS One.

Study authors evaluated whether renin-angiontensin system (RAS) inhibitors, which exert blood pressure lowering and anti-inflammatory effects, could protect against MI in hypertensive patients with RA. Using the Registry for Catastrophic Illness database, the authors identified patients in Taiwan with RA and hypertension from 1995 to 2008. The primary endpoint was MI and the median duration of follow-up was 2,986 days. 

Of the total 27,335 patients, 25.9% received ARBs, 10% received ACEIs,  and 20% received ACEIs or ARBs alternatively. The findings showed a significant decrease in MI incidence among patients treated with ACEIs (hazard ratio [HR] 0.707, 95% CI: 0.595–0.840), ARBs (HR 0.641, 95% CI: 0.550–0.747) and ACEIs/ARBs (HR 0.631, 95% CI: 0.539–0.739).  

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“There was a “dose-response” relationship between treatment duration and the degree of MI risk reduction,” the authors noted. “The results remain robust in most subgroups.”  They concluded by stating that the results of this analysis support the recommendation of RAS inhibitors as preferable drugs for RA patients with hypertension.

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