Angiotensin receptor blockers may increase risk of myocardial infarction unraveling the ARB-MI paradox

摘要: “ To know that we what know, and to do not is true knowledge.” — —Copernicus (1473–1543) Angiotensin-converting enzyme inhibitors (ACEIs) play an important role in the management of patients at increased cardiovascular (CV) risk. ACEIs reduce both myocardial infarction (MI) mortality with symptomatic congestive heart failure or asymptomatic left ventricular dysfunction,1 as evidenced by a class I recommendation American College Cardiology (ACC)/American Heart Association (AHA) guidelines.2 Early administration ACEI after MI reduces 30-day &7%.3 In established vascular disease but normal function, mortality,4 MI,4,5 stroke,4,6 new-onset failure.4,6 are recommended standard therapy ACC7 European Society Cardiology8 guidelines, this independent function concomitant hypertension. The unique cardioprotective benefits also observed diabetes mellitus, who may have coexistent atherosclerosis,9 considered first priority macrovascular risk reduction Canadian Diabetes others.10 Additionally, exert powerful nephroprotection offer marked CV diabetic nephropathy.11,12 Angiotensin II (Ang II) type 1 (AT1) receptor blockers (ARBs), introduced 1995, inhibit renin angiotensin system (RAS) mechanistically distinct fashion from ACEIs. Compared ACEIs, which synthesis Ang II, ARBs competitively selectively bind AT1 receptor, preventing its activation II. particular, able resistance aldosterone release hence help cardiac afterload prevent salt water …