Meta-analysis

Inhibition of renin-angiotensin system prevents new-onset atrial fibrillation

Kishlay Anand, Aryan N. Mooss, Tom T. Hee, Syed M. Mohiuddin

Research output: Contribution to journalReview article

126 Citations (Scopus)

Abstract

Background: Epidemiologic studies suggest that inhibition of renin-angiotensin system with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may prevent development of atrial fibrillation (AF). Objective: The objective of the study was to assess if there is significant indication for using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the prevention of new-onset AF and to identify the target patient population. Methods: PubMed and Cochrane clinical trials database were searched from 1980 through March 2005 together with the review of citations. Nine randomized controlled human trials reporting the prevention of new-onset AF by inhibition of renin-angiotensin system were identified. Information about study design, follow-up, intervention, population, outcomes, and methodology quality was extracted. Results: The mean follow-up of the studies ranged from 6 months to 6.1 year. The pooled estimate using random effects model was 0.82 (95% CI 0.70-0.97) for prevention of new-onset AF and 0.61 (95% CI 0.46-0.83) for primary prevention of AF. The angiotensin-converting enzyme inhibitors (0.75, 95% CI 0.57-0.99) had greater protective effect than angiotensin receptor blockers (0.81, 95% CI 0.62-1.06). Patients with heart failure benefited the most (0.57, 95% CI 0.37-0.89). The test for heterogeneity between studies was significant. There was no consistent visual or statistical evidence of publication bias. Conclusion: The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had an overall effect of 18% risk reduction in new-onset AF across the trials and 43% risk reduction in patients with heart failure.

Original languageEnglish
Pages (from-to)217-222
Number of pages6
JournalAmerican Heart Journal
Volume152
Issue number2
DOIs
StatePublished - Aug 2006

Fingerprint

Renin-Angiotensin System
Atrial Fibrillation
Meta-Analysis
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Risk Reduction Behavior
Heart Failure
Publication Bias
Health Services Needs and Demand
Primary Prevention
PubMed
Epidemiologic Studies
Randomized Controlled Trials
Clinical Trials
Databases
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Meta-analysis : Inhibition of renin-angiotensin system prevents new-onset atrial fibrillation. / Anand, Kishlay; Mooss, Aryan N.; Hee, Tom T.; Mohiuddin, Syed M.

In: American Heart Journal, Vol. 152, No. 2, 08.2006, p. 217-222.

Research output: Contribution to journalReview article

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abstract = "Background: Epidemiologic studies suggest that inhibition of renin-angiotensin system with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may prevent development of atrial fibrillation (AF). Objective: The objective of the study was to assess if there is significant indication for using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the prevention of new-onset AF and to identify the target patient population. Methods: PubMed and Cochrane clinical trials database were searched from 1980 through March 2005 together with the review of citations. Nine randomized controlled human trials reporting the prevention of new-onset AF by inhibition of renin-angiotensin system were identified. Information about study design, follow-up, intervention, population, outcomes, and methodology quality was extracted. Results: The mean follow-up of the studies ranged from 6 months to 6.1 year. The pooled estimate using random effects model was 0.82 (95{\%} CI 0.70-0.97) for prevention of new-onset AF and 0.61 (95{\%} CI 0.46-0.83) for primary prevention of AF. The angiotensin-converting enzyme inhibitors (0.75, 95{\%} CI 0.57-0.99) had greater protective effect than angiotensin receptor blockers (0.81, 95{\%} CI 0.62-1.06). Patients with heart failure benefited the most (0.57, 95{\%} CI 0.37-0.89). The test for heterogeneity between studies was significant. There was no consistent visual or statistical evidence of publication bias. Conclusion: The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had an overall effect of 18{\%} risk reduction in new-onset AF across the trials and 43{\%} risk reduction in patients with heart failure.",
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