European Heart Journal Advance Access originally published online on August 4, 2005
European Heart Journal 2005 26(22):2381-2386; doi:10.1093/eurheartj/ehi445
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Do angiotensin II receptor blockers increase the risk of myocardial infarction?
1Dipartimento Malattie Cardiovascolari, Ospedale R. Silvestrini, 06100 Perugia, Italy
2Dipartimento di Medicina Interna, University of Perugia, Perugia, Italy
Received 22 March 2005; revised 8 July 2005; accepted 14 July 2005; online publish-ahead-of-print 4 August 2005.
* Corresponding author. E-mail address: verdec{at}tin.it
See page 2351 for the editorial comment on this article (doi:10.1093/eurheartj/ehi574)
Aims The uncertainty surrounding safety of angiotensin receptor blockers (ARBs) increased after publication of experimental and clinical studies which suggested an excess risk of myocardial infarction (MI) in people treated with ARBs.
Methods and results We performed a meta-analysis of randomised clinical trials, which compared ARBs with either a placebo or active drugs different from ARBs. Overall, ARBs were not associated with an excess risk of MI [odds ratio (OR): 1.03 in a random-effect model and 1.02 in a fixed-effect model]. In pre-specified subgroup analyses, incidence of MI did not differ between ARBs and either placebo (OR: 0.96; 95% CI: 0.84–1.10) or angiotensin-converting enzyme (ACE)-Inhibitors (OR: 0.99; 95% CI: 0.91–1.07). Incidence of MI was slightly higher with ARBs than with drug classes different from ACE-Inhibitors (OR: 1.16; P=0.06 in a random-effect model and 0.017 in a fixed-effect model). Cardiovascular mortality did not differ between ARBs and drugs different from ARBs (OR: 1.00 in a random-effect model and 0.99 in a fixed-effect model) and it was slightly lesser with ARBs than with placebo (OR: 0.91; 95% CI: 0.83–0.99; P=0.042) in a pre-specified subgroup analysis.
Conclusion Our findings do not support the hypothesis that ARBs increase the risk of MI.
Key Words: Hypertension • Therapy • Myocardial infarction • Prognosis • Prevention • Meta-analysis
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