CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

April 27th, 2011

Large Meta-Analysis Finds No Link Between ARBs and MI Risk

Angiotensin-receptor blockers (ARBs) don’t increase the risk for MI, according to a large new meta-analysis published in BMJ. Concerns about ARBs and MI have lingered since the VALUE trial in 2004 found a 19% increase in the risk for MI, though subsequent trials have not reinforced the finding.

Sripal Bangalore and colleagues combined data from 37 randomized trials including more than 147,000 patients and found no increase in MI risk associated with ARBs when compared with controls (relative risk 0.99, CI 0.92-1.07). The authors wrote that the study provides “firm evidence to refute the hypothesis that angiotensin receptor blockers increase the risk of myocardial infarction (ruling out even a 0.3% absolute increase).” Increases in death or cardiovascular death were similarly ruled out. Furthermore, the researchers found that ARBs were associated with significant reductions in the risks for stroke, heart failure, and diabetes.

Categories: General, Prevention
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3 Responses to “Large Meta-Analysis Finds No Link Between ARBs and MI Risk”

  1. Saurav Chatterjee, MD says:
    April 27, 2011 at 7:33 pm

    very important and impressive study to dispel a controversy!Well done Bangalore et al.

  2. Mauricio Wajngarten, MD PhD says:
    April 28, 2011 at 7:04 am

    The problem is that the study showed that “Despite lower blood pressure with angiotensin receptor blockers when compared with placebo, there also was no detectable beneficial effect for the outcome of myocardial infarction or cardiovascular mortality ” and many doctors, aiming cardioprotection, use ARBs instead of ACEIs because of cough.

    Competing interests pertaining specifically to this post, comment, or both:
    none

  3. Jean-Pierre Usdin, MD says:
    May 1, 2011 at 9:50 am

    This problem of unexpected events makes our patients very suspicious.
    Recently it was said (Bolland and al.) that calcium plus vitamin D increase the risk of myocardial infarction and stroke in post menopausal women, Olmesartan was in the fire of more death, Statin and new onset of diabetes after more cancers…
    Next to the side effects of the medication we have now to reassure the patient who frequently sees in the newspapers or Internet warnings for these not really proven risks. Furthermore it takes then a long time to collect other meta analysis which will refute the “moderate or minimal ” risk.
    Is it the latest fashion?

    Competing interests pertaining specifically to this post, comment, or both:
    no conflicts of interest.