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Angiotensin receptor blockers and risk of myocardial infarction: systematic review

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38595.518542.3A (Published 13 October 2005) Cite this as: BMJ 2005;331:873
  1. Michael A McDonald, resident, cardiology1,
  2. Scot H Simpson, assistant professor2,
  3. Justin A Ezekowitz, resident, cardiology3,
  4. Gabor Gyenes, assistant professor of medicine (cardiology)3,
  5. Ross T Tsuyuki, professor of medicine (cardiology) (ross.tsuyuki{at}ualberta.ca)3
  1. 1 Division of Cardiology, University of Alberta, 2C2 WMC, University of Alberta Hospital, 8440-112 Street, Edmonton, AB, Canada T6G 2B7
  2. 2 Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta. 3126 Dentistry-Pharmacy Centre, Edmonton, AB, Canada T6G 2N8
  3. 3 Division of Cardiology, University of Alberta
  1. Correspondence to: R T Tsuyuki
  • Accepted 1 August 2005

Abstract

Objective To evaluate the effect of angiotensin receptor blockers on the risk of myocardial infarction in patients at risk for cardiovascular events.

Design Systematic review of controlled trials of angiotensin receptor blockers.

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

Selection of studies Predefined criteria were used to select controlled clinical trials comparing use of angiotensin receptor blockers with angiotensin converting enzyme (ACE) inhibitors or placebo in patients at risk for cardiovascular events. Data were extracted for patients' characteristics, interventions, quality of trials, and rates of myocardial infarction.

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

Conclusions Treatment with angiotensin receptor blockers was not associated with a significantly increased risk of myocardial infarction. The 95% confidence intervals do, however, not exclude an increase of up to 16% in the risk of myocardial infarction or a reduction in risk of up to 25%. Until further information specifically dealing with this issue is available from large prospective trials, our findings may alleviate recent concerns over the safety of this class of medications.

Footnotes

  • Contributors All authors took part in the planning and design of the study. MAM, SHS, JAE, and GG did the data collection. SHS did the statistical analyses. All participated in the interpretation of the data. MAM and SHS wrote the first draft of the paper. All authors reviewed and revised the paper for important intellectual content. RTT provided leadership for the study, is the senior and corresponding author, and takes responsibility for the content.

  • Funding None.

  • Competing interests SHS has received honorariums from Merck Frosst and Sanofi-Aventis. GG has received travel grants and honorariums from Aventis, Pfizer, Servier, Novartis, Biovail, AstraZeneca, Merck-Schering, Merck Frosst, and Procter and Gamble. RTT is supported by the Merck Frosst Chair in Patient Health Management from the University of Alberta. He is a member of the Cardiovascular Advisory Board of Merck Frosst and has received honorariums and research grants from Merck Frosst, Merck-Schering, Pfizer, Sanofi-Aventis, and Novartis.

  • Ethical approval Not required.

  • Accepted 1 August 2005
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