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Review
. 2005 Oct 15;331(7521):873.
doi: 10.1136/bmj.38595.518542.3A. Epub 2005 Sep 23.

Angiotensin receptor blockers and risk of myocardial infarction: systematic review

Michael A McDonald  1 , Scot H Simpson, Justin A Ezekowitz, Gabor Gyenes, Ross T Tsuyuki
Affiliations
Review

Angiotensin receptor blockers and risk of myocardial infarction: systematic review

Michael A McDonald et al. BMJ. .

Abstract

Objective: To evaluate the effect of angiotensin receptor blockers on the risk of myocardial infarction in patients at risk for cardiovascular events.

Design: Systematic review of controlled trials of angiotensin receptor blockers.

Data sources: Medline, Embase, Cochrane central register of controlled trials, hand search, and contact with investigators.

Selection of studies: Predefined criteria were used to select controlled clinical trials comparing use of angiotensin receptor blockers with angiotensin converting enzyme (ACE) inhibitors or placebo in patients at risk for cardiovascular events. Data were extracted for patients' characteristics, interventions, quality of trials, and rates of myocardial infarction.

Results: 19 studies with 31,569 patients were included in the analysis. Two studies investigated the use of angiotensin receptor blockers in hypertensive patients, four studies in patients with diabetes and nephropathy, 10 studies in patients with heart failure, and three in patients with recent myocardial infarction or ischaemic syndrome. 11 studies of 21,062 patients allowed for comparison between angiotensin receptor blockers and placebo; nine studies of 10,625 patients allowed for comparison between angiotensin receptor blockers and ACE inhibitors. Use of angiotensin receptor blockers was not associated with increased risk of myocardial infarction compared with placebo (odds ratio 0.94, 95% confidence interval 0.75 to 1.16) nor with increased risk of myocardial infarction compared with ACE inhibitors (1.01, 0.87 to 1.16).

Conclusions: Treatment with angiotensin receptor blockers was not associated with a significantly increased risk of myocardial infarction. The 95% confidence intervals do, however, not exclude an increase of up to 16% in the risk of myocardial infarction or a reduction in risk of up to 25%. Until further information specifically dealing with this issue is available from large prospective trials, our findings may alleviate recent concerns over the safety of this class of medications.

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Figures

Fig 1
Fig 1
Flow diagram showing citations retrieved from literature searches and number of trials included in analysis
Fig 2
Fig 2
Top: Funnel plot of studies comparing angiotensin receptor blockers and placebo. Bottom: Funnel plot of studies comparing angiotensin receptor blockers and angiotensin converting enzyme (ACE) inhibitors
Fig 3
Fig 3
Effect of angiotensin receptor blockers compared with placebo on risk of myocardial infarction
Fig 4
Fig 4
Effect of angiotensin receptor blockers compared with angiotensin converting enzyme inhibitors on risk of myocardial infarction
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References

    1. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325: 293-302. - PubMed
    1. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the cooperative north Scandanavian enalapril survival study (CONSENSUS). N Engl J Med 1987;316: 1429-35. - PubMed
    1. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992;327: 685-91. - PubMed
    1. Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, Cuddy TE, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement trial. N Engl J Med 1992;327: 669-77. - PubMed
    1. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342: 821-8. - PubMed

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