RAS inhibitors 'protect against AF'

RAS inhibitors 'protect against AF': "Friday, August 04, 2006

RAS inhibitors 'protect against AF'
Drugs that inhibit the renin-angiotensin system (RAS) protect against new-onset atrial fibrillation (AF), particularly in patients with heart failure, a meta-analysis has shown. Kishlay Anand and co-workers from Creighton University in Omaha, Nebraska, searched PubMed for randomized controlled clinical trials reporting the incidence of AF in patients receiving ACE inhibitors or angiotensin II type 1 receptor blockers (ARBs). Their meta-analysis included a total of nine studies with 72,469 participants conducted between 1999 and 2005. The median follow-up period was 3.4 years, during which time 3738 new cases of AF were diagnosed. The pooled risk ratio for new-onset AF associated with RAS inhibition was 0.82, Anand and co-authors report in the American Heart Journal. Of the nine trials, just two – STOP-2 (enalapril/lisinopril) and VALUE (valsartan) – failed to show a benefit of treatment on AF incidence. In subgroup analyses, ACE inhibitors had a greater protective effect than ARBs (Risk Ratio [RR]=0.75 vs 0.81) and patients with heart failure benefited the most from RAS blockade (RR=0.57). There was no significant benefit on incident AF in patients with hypertension or myocardial infarction. A test for heterogeneity was significant, however, and the authors were unable to exclude the possibility of publication bias. "Currently, there is not sufficient evidence to recommend the use of ACE inhibitors and ARBs in routine clinical practice for prevention of AF," Anand and team conclude. "Our meta-analysis is hypothesis-generating and will lead to further investigation."
Am Heart J 2006; 152: 217–222