Comparison of Cardiovascular Events in Patients With Angiographically Documented Coronary Narrowing With Combined Renin-Angiotensin System Inhibitor Plus Statin Versus Renin-Angiotensin System Inhibitor Alone Versus Statin Alone (from the Japanese Coronary Artery Disease Study)

Abstract

Statins and renin-angiotensin system (RAS) inhibitors are 2 classes of drugs prescribed frequently in clinical practice that may have pleiotropic effects in addition to cholesterol-lowering and blood pressure-lowering effects, respectively. Combined treatment with statins and RAS inhibitors may have additional benefits beyond each monotherapy. We assessed the usefulness of the combined treatment in the Japanese Coronary Artery Disease (JCAD) Study population. In the JCAD Study, 13,812 patients with angiographically shown narrowing in > or =1 of 3 major coronary arteries were followed up for a mean of 2.7 years. The primary end point of the study was all cardiovascular events. In the present study, baseline covariates possibly influencing the event rate were adjusted between the control and treatment groups. Although there were no statistically significant differences in event rates between patients receiving neither statins nor RAS inhibitors and those receiving either drug, Kaplan-Meier analysis showed a 22% decrease (p = 0.0286) in the event rate with combined treatment. In conclusion, statins combined with RAS inhibitors may decrease cardiovascular events in patients with coronary artery disease.