Two classes of drugs that reduce the likelihood of cardiovascular complications in patients at high risk of heart failure

The present study evaluated the effect of two drug groups – Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) – on cardiovascular (CV)-related events (e.g. heart attacks, strokes), occurence of heart failure (HF) and death, in patients with normal heart functioning.

'Heart failure' (HF) occurs when the heart does not pump blood to the body efficienctly. It is the gradual decline in heart function that follows events and/or conditions the injure the heart muscle, such as heart attacks.

ACEIs (example: Enalapril, or Vasotec) and ARBs (example: Losartan or Cozaar) are related classes of drugs commonly used in patients diagnosed with HF or among heart attack survivors to slow the decline in heart function and reduce risk factors such as high blood pressure. However, it is poorly understood whether these medications prevent CV events or HF in high risk patients (diagnosed with various CV diseases). As a result, these drugs are not commonly prescribed to patients with a normal heart function.

To assess the benefits of ACEIs and ARBs in high risk patients, the authors analysed 26 independent studies. 13 studies examined the effect of ACEIs versus placebo (a substance that has no therapeutic effect, used as a control in testing drugs) and 13 studies examined ARBs versus placebos. Studies included patients without HF or prior CV events (i.e. stroke, heart attack), but at high risk of developing them due to CV diseases, such as diabetes, coronary heart disease, or hypertension. The researchers evaluated the effect of each drug on several outcomes: the risk of heart attack, stroke, new-onset heart failure, new-onset diabetes, and death due to CV events.

Compared to placebos, ACEIs and ARBs both reduced the risk of heart attack, stroke, and death from CV events. ACEIs had the additional benefit of reducing the risk of new-onset heart failure, new-onset diabetes, and death from any cause (including non-CV-related causes).

In contrast to current knowledge, in this study ACEI and ARBs show a clear benefit in high risk patients with normal heart function, without prior CV events. This may expand the use of these drugs to include new patient populations in the future. 

A major weakness of such analysis is that it includes different trials conducted independently, differing in methods and patient charasteristics. For example, ACEI trials mostly included patients with a coronary heart disease. The differences between ACEI and ARB populations does not enable generalizing the results.

If you are at risk of heart failure or CV events, talk to your doctor about ACEIs and ARBs.