ACE Inhibitors Show Lower Risk of MACE for Older Patients With Type 2 Diabetes
Angiotensin-converting enzyme inhibitors have been known to be more effective in decreasing the incidence of major adverse cardiac events for patients with diabetes.
For older patients with type 2 diabetes (T2D), initiating treatment with angiotensin-converting enzyme inhibitors (ACEIs) was associated with a trend toward lower risk of major adverse cardiac events (MACE) compared with angiotensin II receptor blockers (ARBs), according to results of a study published in Cardiovascular Diabetology.1
Angiotensin-converting enzyme inhibitors have been known to be more effective in decreasing the incidence of major adverse cardiac events for patients with diabetes. | Image Credit: sitthiphong - stock.adobe.com
Diabetes is a known risk factor for cardiovascular disease, and those with diabetes have a higher risk of developing and dying from diseases such as myocardial infarction, stroke, and heart failure. Often, hyperglycemia, insulin resistance, obesity, hypertension, nephropathy, and retinopathy are all interconnected. It is recommended for patients to initiate lifestyle changes, including a healthy diet, regular exercise, and weight management, and various therapies to control hyperglycemia and lipid levels.2
ACEs and ARBS are widely utilized in treating heart failure, hypertension, chronic kidney disease, and coronary artery disease, according to the Cleveland Clinic. ACEIs have been known to be more effective in decreasing the incidence of myocardial infarction, cardiovascular death, and all-cause mortality for patients who have hypertension, increased cardiovascular risk, and even diabetes.3
In the current study, investigators aimed to determine the effects of ACEIs and ARBs on MACE for older patients with T2D. They used data from the Yinzhou Regional Health Care Database, which is located in eastern China. Patients included were 65 years and older with T2D who were new users of ACEIs or ARBs between January 1, 2010, and May 31, 2023, according to the study authors. Investigators compared treatment initiation and continued use of ACEIs, which included enalapril, lisinopril, perindopril, benazepril, fosinopril, imidapril, and ramipril, and initiation and continued use of ARBs, which included losartan, valsartan, irbesartan, candesartan, telmisartan, olmesartan, and azilsartan. The primary outcome was 3-point MACE, including hospitalized myocardial infarction, hospitalized stroke, and all-cause mortality. Secondary endpoints included 4-point MACE, which added hospitalized heart failure.1
The study included 18,558 older adults, with 1641 initiating ACEIs and 16,917 initiating ARBs before the cut-off date. Patients primarily used enalapril, benazepril, and perindopril as ACEIs or telmisartan, irbesartan, and valsartan as ARBs. There were 85 events of 3-point MACE occurring among those using ACEIs compared with 1730 among those using ARBs. The incidence rates were 44 and 47.2 per 1000 person-years, respectively, and an adjusted hazard ratio was 0.86, which indicated a slightly lower risk of 3-point MACE among ACEIs. For the secondary end point of 4-point MACE, the adjusted hazard ratio was 0.83. For hospitalized heart failure, stroke, and all-cause mortality separately, investigators found the adjusted hazard ratios of 0.86, 0.80, and 0.87, respectively, which supported the short-term use of ACEIs for cardiovascular benefits among the patient population.1
READ MORE: Diabetes Resource Center
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