Abstract
Renin-angiotensin system (RAS) blockers have potential protective effects against atrial fibrillation (AF). The purpose of this study was to determine if patient characteristics and underlying co-morbidities could predict the efficacy of RAS blockers in AF prevention. Patients aged ≥ 45 years with hypertension were identified from the Taiwan National Health Insurance Research Database. After propensity-score matching, a total of 22,324 patients were included in this study. Risk of new-onset AF in RAS blockers users and non-users was estimated. During up to 10 years of follow-up, 1,475 patients experienced new-onset AF. Overall, RAS blockers reduced the risk of AF by 36% (adjusted HR 0.64; 95% CI 0.58 to 0.71; p < 0.001). Subgroup analysis showed that RAS blockers use was beneficial for AF prevention in patients aged ≥ 55 years or with a CHADS2 score of 1, 2, or 3. The therapy provided no obvious beneficial effect for AF prevention in those aged less than 55 years or with a CHADS2 score ≥ 4. In conclusion, RAS blockers reduced the risk of new-onset AF in patients aged ≥ 55 years or with a CHADS2 score of 1, 2, or 3, but not in patients aged less than 55 years or with a CHADS2 score ≥ 4.
Highlights
Renin-angiotensin system (RAS) blockers have potential protective effects against atrial fibrillation (AF)
The rate of statin, aspirin, alpha-blocker, beta-blocker, calcium channel blocker, diuretics, and digoxin usage was higher among RAS blockers users than non-users (p = 0 .022 for digoxin; p < 0 .001 for other agents)
Our results showed that RAS blockers reduce the risk of new-onset AF in patients aged ≥ 55 years
Summary
Renin-angiotensin system (RAS) blockers have potential protective effects against atrial fibrillation (AF). Male gender, hypertension, heart failure, diabetes mellitus, vascular disease, pulmonary disease, thyroid disease, chronic renal disease, and valvular heart disease are risk factors for AF occurrence[2,3,4,5] Among these risk factors, hypertension is the most common condition and is associated with a 40–50% increased risk of developing new-onset AF3. Our recent studies suggest that CHADS2 scores could be used for predicting the AF preventive effect of statin, another upstream therapy for AF prevention[14,15,16]. The purpose of the present study was to determine if patient characteristics or cardiovascular co-morbidity scoring systems could predict the effectiveness of RAS blockers in primary AF prevention in a nationwide population-based cohort
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