Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT

Azmil H Abdul-Rahim; Kieran F Docherty; Hicham Skali; Lars Køber; Kenneth Dickstein; Aldo P Maggioni; Viacheslav Mareev; Faiez Zannad; Eric J Velazquez; Robert M Califf; Marc A Pfeffer; Scott D Solomon; Kennedy R Lees; John Jv McMurray

doi:10.1177/2396987316646025

Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT

Azmil H Abdul-Rahim, Kieran F Docherty, Hicham Skali, Lars Køber, Kenneth Dickstein, Aldo P Maggioni, Viacheslav Mareev, Faiez Zannad, Eric J Velazquez, Robert M Califf, Marc A Pfeffer, Scott D Solomon, Kennedy R Lees, John Jv McMurray

Afdeling for Hjertesygdomme

Abstract

INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction.

PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group.

RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08).

CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.

Originalsprog	Engelsk
Tidsskrift	European Stroke Journal
Vol/bind	1
Udgave nummer	2
Sider (fra-til)	93-100
Antal sider	8
ISSN	2396-9873
DOI	https://doi.org/10.1177/2396987316646025
Status	Udgivet - jun. 2016

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10.1177/2396987316646025

Citationsformater

Abdul-Rahim, A. H., Docherty, K. F., Skali, H., Køber, L., Dickstein, K., Maggioni, A. P., Mareev, V., Zannad, F., Velazquez, E. J., Califf, R. M., Pfeffer, M. A., Solomon, S. D., Lees, K. R., & McMurray, J. J. (2016). Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT. European Stroke Journal, 1(2), 93-100. https://doi.org/10.1177/2396987316646025

Abdul-Rahim, AH, Docherty, KF, Skali, H, Køber, L, Dickstein, K, Maggioni, AP, Mareev, V, Zannad, F, Velazquez, EJ, Califf, RM, Pfeffer, MA, Solomon, SD, Lees, KR & McMurray, JJ 2016, 'Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT', European Stroke Journal, bind 1, nr. 2, s. 93-100. https://doi.org/10.1177/2396987316646025

@article{c54d701b6b964e22a78c1667ea5316f7,

title = "Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT",

abstract = "INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction.PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group.RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08).CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.",

author = "Abdul-Rahim, {Azmil H} and Docherty, {Kieran F} and Hicham Skali and Lars K{\o}ber and Kenneth Dickstein and Maggioni, {Aldo P} and Viacheslav Mareev and Faiez Zannad and Velazquez, {Eric J} and Califf, {Robert M} and Pfeffer, {Marc A} and Solomon, {Scott D} and Lees, {Kennedy R} and McMurray, {John Jv}",

year = "2016",

month = jun,

doi = "10.1177/2396987316646025",

language = "English",

volume = "1",

pages = "93--100",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

number = "2",

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TY - JOUR

T1 - Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT

AU - Abdul-Rahim, Azmil H

AU - Docherty, Kieran F

AU - Skali, Hicham

AU - Køber, Lars

AU - Dickstein, Kenneth

AU - Maggioni, Aldo P

AU - Mareev, Viacheslav

AU - Zannad, Faiez

AU - Velazquez, Eric J

AU - Califf, Robert M

AU - Pfeffer, Marc A

AU - Solomon, Scott D

AU - Lees, Kennedy R

AU - McMurray, John Jv

PY - 2016/6

Y1 - 2016/6

N2 - INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction.PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group.RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08).CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.

AB - INTRODUCTION: Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction.PATIENTS AND METHODS: We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group.RESULTS: Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08).CONCLUSION: The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.

U2 - 10.1177/2396987316646025

DO - 10.1177/2396987316646025

M3 - Journal article

C2 - 31008270

SN - 2396-9873

VL - 1

SP - 93

EP - 100

JO - European Stroke Journal

JF - European Stroke Journal

IS - 2

ER -

Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT

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