Brugts J J, Arima Hisatomi, Remme W, Bertrand M, Ferrari R, Fox K, DiNicolantonio J, MacMahon S, Chalmers J, Zijlstra F, Caliskan K, Simoons M L, Mourad J J, Boersma E, Akkerhuis K M
Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
The George Institute for Global Health, The Royal Prince Alfred Hospital, Sydney, NSW, Australia; The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
Int J Cardiol. 2014 Oct 20;176(3):718-23. doi: 10.1016/j.ijcard.2014.07.108. Epub 2014 Aug 1.
Our objective was to investigate the actual incidence and clinical determinants of cough leading to discontinuation of ACE-inhibitors. Cough is the most frequent reason to stop ACE-inhibitor treatment.
We studied 27,492 ACE-inhibitor naïve patients randomized to the ACE-inhibitor perindopril or placebo using individual data of 3 clinical trials. Multivariate logistic regression analysis was used to study the incidence of cough in relation to baseline clinical characteristics including racial background.
In 27,492 patients with cardiovascular disease, 1076 patients discontinued ACE-inhibitor perindopril due to cough (3.9%), 703 patients during run-in period of 4 weeks and 373 patients during a mean four years of follow-up. Significant determinants of cough were female gender (OR 1.92 95% CI 1.68-2.18), age above 65 years (OR 1.53 95% CI 1.35-1.73), and concomitant use of lipid-lowering agents (OR 1.37; 95% CI 1.18-1.59). A simple clinical risk score composed of these 3 predictors of cough mounted to an odds ratio of 4.4 (95% CI 3.1-5.4) in the subjects with highest score (i.e. all determinants present). Racial background was not related to a differential incidence of cough in patients of Caucasian or Asian descendent (OR 1.11 95% CI 0.92-1.39).
This large combined analysis of randomized clinical trials in 27,492 patients showed an overall lower incidence of cough leading to discontinuation of ACE-inhibitors (3.9%) as compared to literature. Clinical determinants of such cough are older age, female gender and concomitant use of lipid-lowering agents. In contrast, racial differences were not related to the incidence of cough.
我们的目的是调查导致停用血管紧张素转换酶抑制剂（ACEI）的咳嗽的实际发生率和临床决定因素。咳嗽是停止ACEI治疗最常见的原因。
我们利用3项临床试验的个体数据，研究了27492例初治ACEI患者，这些患者被随机分配接受ACEI培哚普利或安慰剂治疗。采用多因素逻辑回归分析来研究咳嗽发生率与包括种族背景在内的基线临床特征之间的关系。
在27492例心血管疾病患者中，1076例患者因咳嗽停用ACEI培哚普利（3.9%），其中703例在4周的导入期内停药，373例在平均4年的随访期内停药。咳嗽的显著决定因素为女性（比值比1.92，95%置信区间1.68-2.18）、65岁以上（比值比1.53，95%置信区间1.35-1.73）以及同时使用降脂药物（比值比1.37；95%置信区间1.18-1.59）。由这3个咳嗽预测因素组成的简单临床风险评分在得分最高的受试者（即所有决定因素都存在）中升至4.4（95%置信区间3.1-5.4）。种族背景与白种人或亚洲裔患者咳嗽的差异发生率无关（比值比1.11，95%置信区间0.92-1.39）。
这项对27492例患者进行的随机临床试验的大型综合分析显示，与文献报道相比，导致停用ACEI的咳嗽总体发生率较低（3.9%）。此类咳嗽的临床决定因素为年龄较大、女性以及同时使用降脂药物。相比之下，种族差异与咳嗽发生率无关。
