Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy

Chen-Yu Huang, Yao-Hsu Yang, Lian-Yu Lin, Chia-Ti Tsai, Juey-Jen Hwang, Pau-Chung Chen, Jiunn-Lee Lin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.

METHODS: We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.

RESULTS: Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.

CONCLUSION: In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.

Original languageEnglish
JournalHeart
DOIs
Publication statusE-pub ahead of print - Jan 25 2018
Externally publishedYes

Fingerprint

Hypertrophic Cardiomyopathy
Angiotensins
Aldosterone
Renin
Atrial Fibrillation
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Propensity Score
Renin-Angiotensin System
Heart Failure
Retrospective Studies
Databases
Mortality
Health
Therapeutics

Cite this

Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy. / Huang, Chen-Yu; Yang, Yao-Hsu; Lin, Lian-Yu; Tsai, Chia-Ti; Hwang, Juey-Jen; Chen, Pau-Chung; Lin, Jiunn-Lee.

In: Heart, 25.01.2018.

Research output: Contribution to journalArticle

Huang, Chen-Yu ; Yang, Yao-Hsu ; Lin, Lian-Yu ; Tsai, Chia-Ti ; Hwang, Juey-Jen ; Chen, Pau-Chung ; Lin, Jiunn-Lee. / Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy. In: Heart. 2018.
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title = "Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy",
abstract = "OBJECTIVES: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.METHODS: We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.RESULTS: Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16{\%} vs 5.65{\%}, relative risk 0.56 (95{\%} CI 0.49 to 0.64), HR 0.572 (95{\%} CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.CONCLUSION: In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.",
author = "Chen-Yu Huang and Yao-Hsu Yang and Lian-Yu Lin and Chia-Ti Tsai and Juey-Jen Hwang and Pau-Chung Chen and Jiunn-Lee Lin",
note = "{\circledC} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2018",
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T1 - Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy

AU - Huang, Chen-Yu

AU - Yang, Yao-Hsu

AU - Lin, Lian-Yu

AU - Tsai, Chia-Ti

AU - Hwang, Juey-Jen

AU - Chen, Pau-Chung

AU - Lin, Jiunn-Lee

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/1/25

Y1 - 2018/1/25

N2 - OBJECTIVES: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.METHODS: We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.RESULTS: Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.CONCLUSION: In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.

AB - OBJECTIVES: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.METHODS: We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.RESULTS: Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.CONCLUSION: In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.

U2 - 10.1136/heartjnl-2017-312573

DO - 10.1136/heartjnl-2017-312573

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C2 - 29371376

JO - Heart

JF - Heart

SN - 1355-6037

ER -