J Appl Biomed 21:7-14, 2023 | DOI: 10.32725/jab.2023.002

Comparison of cardiocerebrovascular disease incidence between angiotensin converting enzyme inhibitor and angiotensin receptor blocker users in a real-world cohort

Suehyun Lee¹, Hyunah Kim², Hyeon Woo Yim³, Hun-Sung Kim^{4, 5, * a}, Ju Han Kim^{6, * a}

¹ Gachon University, Department of Computer Engineering, Seongnam, Republic of Korea

² Sookmyung Women's University, College of Pharmacy, Seoul, Republic of Korea

³ The Catholic University of Korea, College of Medicine, Department of Preventive Medicine, Seoul, Republic of Korea

⁴ The Catholic University of Korea, College of Medicine, Department of Medical Informatics, Seoul, Republic of Korea

⁵ Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul, Republic of Korea

⁶ Seoul National University College of Medicine, Systems Biomedical Informatics Research Center, Division of Biomedical Informatics, Seoul, Republic of Korea

Background: Both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are known to be effective in managing cardiovascular diseases, but more evidence supports the use of an ACEI. This study investigated the difference in cardiovascular disease incidence between relatively low-compliance ACEIs and high-compliance ARBs in the clinical setting.

Methods: Patients who were first prescribed ACEIs or ARBs at two tertiary university hospitals in Korea were observed in this retrospective cohort study for the incidence of heart failure, angina, acute myocardial infarction, cerebrovascular disease, ischemic heart disease, and major adverse cardiovascular events for 5 years after the first prescription. Additionally, 5-year Kaplan-Meier survival curves were used based on the presence or absence of statins.

Results: Overall, 2,945 and 9,189 patients were prescribed ACEIs and ARBs, respectively. When compared to ACEIs, the incidence of heart failure decreased by 52% in those taking ARBs (HR [95% CI] = 0.48 [0.39-0.60], P < 0.001), and the incidence of cerebrovascular disease increased by 62% (HR [95% CI] = 1.62 [1.26-2.07], P < 0.001). The incidence of ischemic heart disease (P = 0.223) and major adverse cardiovascular events (P = 0.374) did not differ significantly between the two groups.

Conclusions: ARBs were not inferior to ACEIs in relation to reducing the incidence of cardiocerebrovascular disease in the clinical setting; however, there were slight differences for each disease. The greatest strength of real-world evidence is that it allows the follow-up of specific drug use, including drug compliance. Large-scale studies on the effects of relatively low-compliance ACEIs and high-compliance ARBs on cardiocerebrovascular disease are warranted in the future.

Keywords: ACEI; Acute myocardial infarction; ARB; Cerebrovascular disease; Heart failure

Conflicts of interest:

The authors have no competing interests to declare.

Received: July 8, 2022; Revised: November 8, 2022; Accepted: March 22, 2023; Prepublished online: March 27, 2023; Published: April 1, 2023  Show citation