Renin‐angiotensin‐aldosterone system inhibitors and major cardiovascular events and acute kidney injury in patients with coronary artery disease. Issue 12 (22nd September 2021)

• Record Type: Journal Article
• Authors: Sud, Maneesh; Ko, Dennis T.; Chong, Alice; Koh, Maria; Azizi, Paymon M.; Austin, Peter C.; Stukel, Thérèse A.; Jackevicius, Cynthia A.
• Other Names: Baker William L. guestEditor.; Jackevicius Cynthia A. guestEditor.
• Is Part Of: Pharmacotherapy. Volume 41:Issue 12(2021)
• Page Start: 988
• Page End: 997
• Publication Date: 2021-09-22
• Subjects: acute Kidney Injury -- Angiotensin Converting Enzymes -- angiotensin Receptor Blockers -- coronary artery disease -- Major adverse cardiac outcomes; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; Drug Therapy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1002/phar.2624
• Languages: English
• ISSNs: 0277-0008

Abstract

Abstract: Background: Renin‐angiotensin‐aldosterone system inhibitors (RAASIs) are recommended for most patients with coronary artery disease (CAD). However, there is debate across guidelines as to which patients with CAD benefit the most from these agents. This study investigated the association between RAASIs and cardiovascular outcomes and acute kidney injury in a contemporary cohort of patients with CAD. Methods: Patients ≥65 years of age with CAD alive on April 1, 2012 in Ontario, Canada were included. Outcomes included major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction (MI), unstable angina, stroke, or coronary revascularization), and acute kidney injury (AKI) hospitalizations at 4 years. Inverse probability of treatment‐weighted Cox proportional hazards regression models was used to compare the rates of each outcome in patients treated with and without RAASIs (angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers). Results: There were 165, 058 patients with CAD identified (mean age 75 years, 65.5% male, 64.7% prescribed RAASIs). After inverse‐probability weighting, treatment with RAASIs was associated with a lower rate of MACE compared with treatment without RAASIs (17.6% vs 18.2%, hazard ratio [HR]: 0.96, 95% CI: 0.93–0.99, respectively). However, treatment with RAASIs was associated with a higher rate of AKI compared with treatment without RAASIs (1.7% vs 1.5%, HR: 1.14, 95% CI: 1.02–1.29, respectively). The reduction in MACE was greater in patients with prior MI (HR: 0.87, 95% CI: 0.82–0.92) compared with patients without prior MI (HR: 1.00, 95% CI: 0.97–1.04, interaction p < 0.01). The increase in AKI was lower in patients with prior MI (HR: 0.82, 95% CI: 0.66–1.00) compared with patients without prior MI (HR: 1.37, 95% CI: 1.19–1.57, interaction p < 0.01). Conclusions: This study supports the continued use of RAASIs in patients with CAD, although the benefit appears smaller in magnitude than observed in prior trials. High‐risk patients, particularly those with prior MI, appear to benefit the most from RAASIs.