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ACEI/ARB therapy for aortic stenosis
Drugs that block the renin-angiotensin system are not only safe, they are beneficial in patients with aortic stenosis (AS) according to a new study. This runs counter to current recommendations that suggest that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are relatively contraindicated in patients with AS. The study looked at more than 2000 patients with AS in Scotland, of which the majority had mild-to-moderate stenosis, while about one-quarter had severe AS. Of the total number, nearly 700 were on ACEI or ARB therapy. Over a mean follow-up of 4.2 years, just over half the patients died, of which 48% died from cardiovascular (CV) deaths. Those treated with ACEIs or ARBs had a significantly lower mortality rate (adjusted hazard ratio [HR] 0.76; confidence interval [CI] 0.67-0.92; P < 0.0001) and fewer CV events (adjusted HR 0.77; 95% CI: 0.65-0.92; P < 0.0001) compared to those not on ACEIs/ARBs. The authors conclude that ACEI/ARB therapy is associated with improved survival and lower risk of CV events in patients with AS. These findings were consistent in patients with nonsevere and severe AS. The rate of valve replacement also was lower in patients treated with ACEIs/ARBs (J Am Coll Cardiol 2011;58:570-576). This study was a retrospective observational study and prospective, randomized, controlled trials are warranted to confirm these findings.