Angiotensin receptor blockers and risk of myocardial infarction: systematic review

doi:10.1136/bmj.38595.518542.3A

BMJ 2005;331:873 (15 October), doi:10.1136/bmj.38595.518542.3A (published 23 September 2005)

Paper

Angiotensin receptor blockers and risk of myocardial infarction: systematic review

Michael A McDonald, resident, cardiology¹, Scot H Simpson, assistant professor², Justin A Ezekowitz, resident, cardiology³, Gabor Gyenes, assistant professor of medicine (cardiology)³, Ross T Tsuyuki, professor of medicine (cardiology)³

¹ Division of Cardiology, University of Alberta, 2C2 WMC, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7, ² Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta. 3126 Dentistry-Pharmacy Centre, Edmonton, AB, Canada T6G 2N8, ³ Division of Cardiology, University of Alberta

Correspondence to: R T Tsuyuki ross.tsuyuki{at}ualberta.ca

Objective To evaluate the effect of angiotensin receptor blockerson the risk of myocardial infarction in patients at risk forcardiovascular events.

Design Systematic review of controlled trials of angiotensinreceptor blockers.

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

Selection of studies Predefined criteria were used to selectcontrolled clinical trials comparing use of angiotensin receptorblockers with angiotensin converting enzyme (ACE) inhibitorsor placebo in patients at risk for cardiovascular events. Datawere extracted for patients' characteristics, interventions,quality of trials, and rates of myocardial infarction.

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

Conclusions Treatment with angiotensin receptor blockers wasnot associated with a significantly increased risk of myocardialinfarction. The 95% confidence intervals do, however, not excludean increase of up to 16% in the risk of myocardial infarctionor a reduction in risk of up to 25%. Until further informationspecifically dealing with this issue is available from largeprospective trials, our findings may alleviate recent concernsover the safety of this class of medications.

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