Do angiotensin II receptor blockers increase the risk of myocardial infarction?

Aims: The uncertainty surrounding safety of angiotensin receptor blockers (ARBs) increased after publication of experimental and clinical studies which suggested an excess risk of myocardial infarction (MI) in people treated with ARBs.

Methods And Results: We performed a meta-analysis of randomised clinical trials, which compared ARBs with either a placebo or active drugs different from ARBs. Overall, ARBs were not associated with an excess risk of MI [odds ratio (OR): 1.03 in a random-effect model and 1.02 in a fixed-effect model]. In pre-specified subgroup analyses, incidence of MI did not differ between ARBs and either placebo (OR: 0.96; 95% CI: 0.84-1.10) or angiotensin-converting enzyme (ACE)-Inhibitors (OR: 0.99; 95% CI: 0.91-1.07). Incidence of MI was slightly higher with ARBs than with drug classes different from ACE-Inhibitors (OR: 1.16; P=0.06 in a random-effect model and 0.017 in a fixed-effect model). Cardiovascular mortality did not differ between ARBs and drugs different from ARBs (OR: 1.00 in a random-effect model and 0.99 in a fixed-effect model) and it was slightly lesser with ARBs than with placebo (OR: 0.91; 95% CI: 0.83-0.99; P=0.042) in a pre-specified subgroup analysis.

Conclusion: Our findings do not support the hypothesis that ARBs increase the risk of MI.