Effect of renin-angiotensin-aldosterone system inhibitors on all-cause mortality and major cardiovascular events in patients with diabetes: A meta-analysis focusing on the number needed to treat and minimal clinical effect.

Autor: Yang XC; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Shao LL; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Mi YJ; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China; Department of Social Medicine and Health Care Management, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China., Zhang WH; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Liu NY; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Liu RB; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Zhou XX; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China., Zhang WH; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent. Belgium C. Heymanslaan 10, Entrance 75/ICRH, 9000 Gent, Belgium., Tian QB; Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang 050017, China; Hebei Province Key Laboratory of Environment and Human Health, 361 East Zhongshan Road, Shijiazhuang 050017, China. Electronic address: tqb1980@hebmu.edu.cn.
Jazyk: angličtina
Zdroj: Journal of diabetes and its complications [J Diabetes Complications] 2021 Mar; Vol. 35 (3), pp. 107830. Date of Electronic Publication: 2020 Dec 31.
DOI: 10.1016/j.jdiacomp.2020.107830
Abstrakt: Aims: To assess the effectiveness of renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) separately to prevent all-cause mortality, myocardial infarction (MI), stroke and heart failure (HF) in patients with diabetes considering the number needed to treat (NNT) and minimal clinical effect (MCE).
Methods: Data from 17 morbidity-mortality trials in patients with diabetes were used to calculate NNTs and evaluate MCE to prevent all-cause mortality, myocardial infarction, stroke, and heart failure.
Results: A total of 17 trials involving 42,037 patients were included in this meta-analysis. Mean follow-up was 3.7 years. ACEIs significantly reduced the risk of all-cause mortality, MI and HF; the corresponding mean NNTBs were 48, 62 and 78, respectively, but ARBs were only associated with a reduction in heart failure. The clinical significance assessment of the included trials indicated that most of the statistically significant trial results had no definitive clinical significance, and only some of them had possible clinical significance.
Conclusions: Among patients with diabetes, ACEIs reduced all-cause mortality, MI and HF, whereas ARBs could only prevent HF. However, none of the results of these trials had clear clinical significance, and most had only possible clinical significance.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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