Abstract | BACKGROUND:
Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF. METHODS: Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality. RESULTS: During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses. CONCLUSIONS: These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.
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Authors | Henrik Svanström, Björn Pasternak, Mads Melbye, Anders Hviid |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 182
Pg. 90-6
(Mar 01 2015)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 25576729
(Publication Type: Journal Article)
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Copyright | Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. |
Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
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Topics |
- Aged
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Cause of Death
(trends)
- Denmark
(epidemiology)
- Female
- Heart Failure, Systolic
(drug therapy, mortality)
- Humans
- Male
- Prospective Studies
- Registries
- Survival Rate
(trends)
- Treatment Outcome
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