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A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients: a population-based dynamic cohort study in Taiwan.
Cardiovasc Diabetol. 2016 Apr 02; 15:56.CD

Abstract

BACKGROUND

Contemporary guidelines recommend angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) for hypertensive patients with diabetes. However, there is limited data to evaluate the comparison between ACEi and ARB on end stage renal disease (ESRD) and major adverse cardiovascular events (MACE), in Asian diabetic patients.

METHODS

We used the Taiwan Longitudinal Cohort of Diabetes Patients Database to perform a population-based dynamic cohort study. The comparison between ACEi and ARB on ESRD and MACE in diabetic patients was examined using the propensity score weighting method. We followed these patients until the occurrence of first study outcomes or end date of the study, whichever came first.

RESULTS

There were 6898 and 12,758 patients in ACEi and ARB groups, respectively. The mean follow-up period was about 3.5 years in ESRD and 2.5 years in MACE. The incidence of ESRD was 0.44 % and 0.63 % per person-years in the ACEi and ARB group, respectively. The risk of ESRD was lower in the ACEi group than the ARB group [hazard ratio (HR) 0.69; 95 % confidence interval (CI) 0.54-0.88, P = 0.0025]. Among those without chronic kidney disease (CKD), the incidence of ESRD was 0.30 % and 0.37 % per person-years in the ACEi and ARB group, respectively. ACEi was similar to ARB in preventing ESRD for those without CKD (P = 0.11). Among those with CKD, the incidence of ESRD was 1.39 % and 2.34 % per person-years in the ACEi and ARB group, respectively. The ACEi group had a lower risk of ESRD than the ARB group (HR 0.61; 95 % CI 0.42-0.88, P = 0.008). The incidence of MACE was 9.33 % and 9.62 % per person-years in the ACEi and ARB group, respectively. There was no significant difference in the composite MACE outcome between the two groups (P = 0.42), but the ACEi group was associated with a higher risk of stroke than the ARB group (HR 1.12; 95 % CI 1.02-1.24, P = 0.02).

CONCLUSIONS

ACEi compared with ARB was associated with a lower incidence of ESRD, especially in those with CKD. Though ACEi and ARB had a similar risk of composite MACE outcome, ACEi had a slightly higher incidence of stroke than ARB, among the Asian diabetic patients.

Authors+Show Affiliations

Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Graduate Institute of Clinical Medicinal Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.Department of Public Health, College of Medicine, and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Linkou, Tao-Yuan, Taiwan.Department of Public Health, College of Medicine, and Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan. lichu@mail.cgu.edu.tw. Division of Rheumationalogy and Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan. lichu@mail.cgu.edu.tw.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27039185

Citation

Wu, Lung-Sheng, et al. "A Comparison Between Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers On End Stage Renal Disease and Major Adverse Cardiovascular Events in Diabetic Patients: a Population-based Dynamic Cohort Study in Taiwan." Cardiovascular Diabetology, vol. 15, 2016, p. 56.
Wu LS, Chang SH, Chang GJ, et al. A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients: a population-based dynamic cohort study in Taiwan. Cardiovasc Diabetol. 2016;15:56.
Wu, L. S., Chang, S. H., Chang, G. J., Liu, J. R., Chan, Y. H., Lee, H. F., Wen, M. S., Chen, W. J., Yeh, Y. H., Kuo, C. T., & See, L. C. (2016). A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients: a population-based dynamic cohort study in Taiwan. Cardiovascular Diabetology, 15, 56. https://doi.org/10.1186/s12933-016-0365-x
Wu LS, et al. A Comparison Between Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers On End Stage Renal Disease and Major Adverse Cardiovascular Events in Diabetic Patients: a Population-based Dynamic Cohort Study in Taiwan. Cardiovasc Diabetol. 2016 Apr 2;15:56. PubMed PMID: 27039185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison between angiotensin converting enzyme inhibitors and angiotensin receptor blockers on end stage renal disease and major adverse cardiovascular events in diabetic patients: a population-based dynamic cohort study in Taiwan. AU - Wu,Lung-Sheng, AU - Chang,Shang-Hung, AU - Chang,Gwo-Jyh, AU - Liu,Jia-Rou, AU - Chan,Yi-Hsin, AU - Lee,Hsin-Fu, AU - Wen,Ming-Shien, AU - Chen,Wei-Jan, AU - Yeh,Yung-Hsin, AU - Kuo,Chi-Tai, AU - See,Lai-Chu, Y1 - 2016/04/02/ PY - 2015/12/24/received PY - 2016/3/10/accepted PY - 2016/4/4/entrez PY - 2016/4/4/pubmed PY - 2017/2/25/medline KW - Angiotensin converting enzyme inhibitors KW - Angiotensin receptor blockers KW - Diabetes mellitus KW - End-stage renal disease KW - Major adverse cardiovascular events SP - 56 EP - 56 JF - Cardiovascular diabetology JO - Cardiovasc Diabetol VL - 15 N2 - BACKGROUND: Contemporary guidelines recommend angiotensin-converting-enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARB) for hypertensive patients with diabetes. However, there is limited data to evaluate the comparison between ACEi and ARB on end stage renal disease (ESRD) and major adverse cardiovascular events (MACE), in Asian diabetic patients. METHODS: We used the Taiwan Longitudinal Cohort of Diabetes Patients Database to perform a population-based dynamic cohort study. The comparison between ACEi and ARB on ESRD and MACE in diabetic patients was examined using the propensity score weighting method. We followed these patients until the occurrence of first study outcomes or end date of the study, whichever came first. RESULTS: There were 6898 and 12,758 patients in ACEi and ARB groups, respectively. The mean follow-up period was about 3.5 years in ESRD and 2.5 years in MACE. The incidence of ESRD was 0.44 % and 0.63 % per person-years in the ACEi and ARB group, respectively. The risk of ESRD was lower in the ACEi group than the ARB group [hazard ratio (HR) 0.69; 95 % confidence interval (CI) 0.54-0.88, P = 0.0025]. Among those without chronic kidney disease (CKD), the incidence of ESRD was 0.30 % and 0.37 % per person-years in the ACEi and ARB group, respectively. ACEi was similar to ARB in preventing ESRD for those without CKD (P = 0.11). Among those with CKD, the incidence of ESRD was 1.39 % and 2.34 % per person-years in the ACEi and ARB group, respectively. The ACEi group had a lower risk of ESRD than the ARB group (HR 0.61; 95 % CI 0.42-0.88, P = 0.008). The incidence of MACE was 9.33 % and 9.62 % per person-years in the ACEi and ARB group, respectively. There was no significant difference in the composite MACE outcome between the two groups (P = 0.42), but the ACEi group was associated with a higher risk of stroke than the ARB group (HR 1.12; 95 % CI 1.02-1.24, P = 0.02). CONCLUSIONS: ACEi compared with ARB was associated with a lower incidence of ESRD, especially in those with CKD. Though ACEi and ARB had a similar risk of composite MACE outcome, ACEi had a slightly higher incidence of stroke than ARB, among the Asian diabetic patients. SN - 1475-2840 UR - https://www.unboundmedicine.com/medline/citation/27039185/A_comparison_between_angiotensin_converting_enzyme_inhibitors_and_angiotensin_receptor_blockers_on_end_stage_renal_disease_and_major_adverse_cardiovascular_events_in_diabetic_patients:_a_population_based_dynamic_cohort_study_in_Taiwan_ DB - PRIME DP - Unbound Medicine ER -