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The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
J Am Coll Cardiol. 2006 Feb 21; 47(4):726-33.JACC

Abstract

OBJECTIVES

We attempted to compare the effect of an angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) on atherosclerotic events.

BACKGROUND

Angiotensin-converting enzyme inhibitors and ARBs interrupt the renin-angiotensin system by distinct mechanisms. It is not clear whether ARBs reduce atherosclerotic events such as myocardial infarction (MI) like ACE inhibitors. This evidence gap may reflect the nature of the studies conducted, to date. Placebo-controlled studies enrolled cohorts at low risk of atherosclerotic events (e.g., patients with chronic heart failure, most treated with an ACE inhibitor). One of the main active controlled trials was confounded by a blood pressure difference between treatments.

METHODS

We compared the effects of captopril, valsartan, and their combination on atherosclerotic events in 14,703 patients randomized in the Valsartan in Acute Myocardial Infarction Trial (VALIANT).

RESULTS

The number of individuals adjudicated as having a fatal or non-fatal MI in the captopril group was 559 (total investigator reported events 798), 587 (796) in the valsartan group, and 554 (756) in the combination group; valsartan versus captopril, p = 0.651 (0.965); combination versus captopril, p = 0.187 (0.350). Overall, all atherosclerotic events examined occurred at a similar frequency in the captopril and valsartan groups.

CONCLUSIONS

Angiotensin receptor blockers appear to be as effective as ACE inhibitors in reducing atherosclerotic events, even when used in addition to other secondary preventive treatments. These data, although not conclusive, also support the hypothesis that adding an ARB to an ACE inhibitor may have a small additional anti-infarction effect, a possibility that needs to be prospectively tested.

Authors+Show Affiliations

Department of Cardiology, Western Infirmary, Glasgow, Scotland, United Kingdom. j.mcmurray@bio.gla.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16487836

Citation

McMurray, John, et al. "The Effect of Valsartan, Captopril, or Both On Atherosclerotic Events After Acute Myocardial Infarction: an Analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)." Journal of the American College of Cardiology, vol. 47, no. 4, 2006, pp. 726-33.
McMurray J, Solomon S, Pieper K, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006;47(4):726-33.
McMurray, J., Solomon, S., Pieper, K., Reed, S., Rouleau, J., Velazquez, E., White, H., Howlett, J., Swedberg, K., Maggioni, A., Køber, L., Van de Werf, F., Califf, R., & Pfeffer, M. (2006). The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Journal of the American College of Cardiology, 47(4), 726-33.
McMurray J, et al. The Effect of Valsartan, Captopril, or Both On Atherosclerotic Events After Acute Myocardial Infarction: an Analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006 Feb 21;47(4):726-33. PubMed PMID: 16487836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). AU - McMurray,John, AU - Solomon,Scott, AU - Pieper,Karen, AU - Reed,Shelby, AU - Rouleau,Jean, AU - Velazquez,Eric, AU - White,Harvey, AU - Howlett,Jonathan, AU - Swedberg,Karl, AU - Maggioni,Aldo, AU - Køber,Lars, AU - Van de Werf,Frans, AU - Califf,Rob, AU - Pfeffer,Marc, Y1 - 2006/01/26/ PY - 2005/06/22/received PY - 2005/08/22/revised PY - 2005/09/08/accepted PY - 2006/2/21/pubmed PY - 2006/4/29/medline PY - 2006/2/21/entrez SP - 726 EP - 33 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 47 IS - 4 N2 - OBJECTIVES: We attempted to compare the effect of an angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) on atherosclerotic events. BACKGROUND: Angiotensin-converting enzyme inhibitors and ARBs interrupt the renin-angiotensin system by distinct mechanisms. It is not clear whether ARBs reduce atherosclerotic events such as myocardial infarction (MI) like ACE inhibitors. This evidence gap may reflect the nature of the studies conducted, to date. Placebo-controlled studies enrolled cohorts at low risk of atherosclerotic events (e.g., patients with chronic heart failure, most treated with an ACE inhibitor). One of the main active controlled trials was confounded by a blood pressure difference between treatments. METHODS: We compared the effects of captopril, valsartan, and their combination on atherosclerotic events in 14,703 patients randomized in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). RESULTS: The number of individuals adjudicated as having a fatal or non-fatal MI in the captopril group was 559 (total investigator reported events 798), 587 (796) in the valsartan group, and 554 (756) in the combination group; valsartan versus captopril, p = 0.651 (0.965); combination versus captopril, p = 0.187 (0.350). Overall, all atherosclerotic events examined occurred at a similar frequency in the captopril and valsartan groups. CONCLUSIONS: Angiotensin receptor blockers appear to be as effective as ACE inhibitors in reducing atherosclerotic events, even when used in addition to other secondary preventive treatments. These data, although not conclusive, also support the hypothesis that adding an ARB to an ACE inhibitor may have a small additional anti-infarction effect, a possibility that needs to be prospectively tested. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16487836/The_effect_of_valsartan_captopril_or_both_on_atherosclerotic_events_after_acute_myocardial_infarction:_an_analysis_of_the_Valsartan_in_Acute_Myocardial_Infarction_Trial__VALIANT__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)02798-1 DB - PRIME DP - Unbound Medicine ER -