Wemmelund Holger, Høgh Annette, Hundborg Heidi H, Johnsen Søren P, Lindholt Jes S
Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Pharmacoepidemiol Drug Saf. 2016 Feb;25(2):141-50. doi: 10.1002/pds.3913. Epub 2015 Nov 17.
Rupture of abdominal aortic aneurysms (rAAA) is associated with high mortality. Use of angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) has been suggested to reduce the risk of rAAA. This nationwide, combined case-control and follow-up study aims to examine the possible impact of preadmission renin-angiotensin system blockade on the risk of rAAA and case fatality following rAAA.
Using Danish healthcare registries, a combined case-control and follow-up study was conducted among all patients with a first-time hospital admission for rAAA and AAA controls without rupture in Denmark from 1996 to 2012. Individual-level data were obtained on preadmission drug use, comorbidity, socioeconomic factors, healthcare services use, and death.
The adjusted age-matched and sex-matched odds ratios (adj. OR) were 0.96 (95% confidence interval (CI): 0.85; 1.07) for rAAA for current ACE-inhibitor users and 0.93 (95%CI: 0.79; 1.09) for current ARB users compared with never users. Propensity score-matched analyses yielded similar results for current ACE-inhibitor users (adj. OR: 1.02, 95%CI: 0.88; 1.19) and current ARB users (adj. OR: 1.02, 95%CI: 0.83; 1.26). The total 30-day mortality rate after hospital admission was 61.0% in current ACE-inhibitor users compared with 59.4% in non-ACE-inhibitor users (adjusted mortality rate ratio (adj. MRR) 1.06, 95%CI: 0.94; 1.20) and 58.6% in current ARB users compared with 59.9% in non-ARB users (adj. MRR: 0.96, 95%CI: 0.82; 1.14).
Use of renin-angiotensin system blockade was not associated with a lower risk of rAAA or lower case fatality following rAAA.
腹主动脉瘤破裂（rAAA）与高死亡率相关。有人提出使用血管紧张素转换酶抑制剂（ACE抑制剂）和血管紧张素受体阻滞剂（ARB）可降低rAAA风险。这项全国性的病例对照与随访联合研究旨在探讨入院前肾素-血管紧张素系统阻断对rAAA风险及rAAA后病死率的可能影响。
利用丹麦医疗保健登记系统，对1996年至2012年丹麦所有首次因rAAA入院的患者以及未破裂的AAA对照患者进行了病例对照与随访联合研究。获取了个体层面关于入院前用药、合并症、社会经济因素、医疗服务使用情况及死亡情况的数据。
与从未使用者相比，当前使用ACE抑制剂的患者发生rAAA的校正年龄匹配和性别匹配优势比（adj. OR）为0.96（95%置信区间（CI）：0.85；1.07），当前使用ARB的患者为0.93（95%CI：0.79；1.09）。倾向评分匹配分析得出当前使用ACE抑制剂的患者（adj. OR：1.02，95%CI：0.88；1.19）和当前使用ARB的患者（adj. OR：1.02，95%CI：0.83；1.26）有相似结果。入院后30天总死亡率在当前使用ACE抑制剂的患者中为61.0%，在未使用ACE抑制剂的患者中为59.4%（校正死亡率比（adj. MRR）1.06，95%CI：0.94；1.20），在当前使用ARB的患者中为58.6%，在未使用ARB的患者中为59.9%（adj. MRR：0.96，95%CI：0.82；1.14）。
肾素-血管紧张素系统阻断的使用与rAAA风险降低或rAAA后病死率降低无关。
