Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Benefits With HIGH Levels of Evidence That Result From Adding an ARB to Standard Medical Therapy for Stable Ischemic Heart Disease With Preserved Left Ventricular Systolic Function*
The Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (TRANSCEND) trial (Yusuf et al., 2008) was the only trial that met the inclusion criteria for the addition of an angiotensin II-receptor blocker (ARB) to standard medical therapy for patients with stable ischemic heart disease (IHD) and preserved left ventricular function (LVSF) as compared to standard medical therapy alone or with a placebo. Patients who could not tolerate angiotensin-converting enzyme inhibitors (ACEIs) were enrolled in the study and were treated with telmisartan.
The results of this trial showed that the difference in event rates between the two treatment groups to be less than 2. On average, 56 patients who have stable IHD and preserved LVSF and cannot tolerate ACEIs will need to be treated with an ARB over 5 years to prevent one or more of the following events: cardiovascular death, nonfatal myocardial infarction, or stroke. In other words, on average, 14.8 of every 100 patients will experience one or more of these cardiovascular events in the next 5 years. If an ARB were to be added to the treatment regimens of 100 patients, 13 of them would have a risk of suffering one or more of these cardiovascular events. The relative risk reduction in the combined risk for cardiovascular death, nonfatal myocardial infarction, or stroke is 12%.
All of these data were determined to be at a high level of evidence, meaning that future trials are unlikely to change the estimated differences between these treatment groups.
- Agency for Healthcare Research and Quality. Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews, Version 1.0 [Draft posted Oct. 2007]. Rockville, MD.
- Coleman CI, Baker WL, Kluger J, et al. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. Comparative Effectiveness Review No. 18. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) Rockville, MD: Agency for Healthcare Research and Quality; October 2009.
- Yusuf S, Teo K, Anderson C, et al, for the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (TRANSCEND) Investigators. Effects of angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial. Lancet 2008; 372:1174-83.
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