What is the clinical evidence from this study?

Study design: Cohort. Population: Atherosclerotic cardiovascular disease (ASCVD) (n=1203920). Intervention: Angiotensin receptor blocker (ARB) vs. Angiotensin-converting enzyme inhibitor (ACEI). Primary outcome: 1-year major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, or all-cause mortality) (HR 0.77, 95% CI 0.76-0.78, p=<.001).

What does this research mean for the field?

In patients with atherosclerotic cardiovascular disease, the use of angiotensin receptor blockers is associated with a lower short-term risk of major adverse cardiovascular events compared to angiotensin-converting enzyme inhibitors, though this may reflect differences in treatment patterns rather than intrinsic pharmacologic superiority. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to evaluate the association of ARB and ACEI use with cardiovascular outcomes in ASCVD patients.

June 20, 2026Mayo Clinic Proceedings

Association Between Angiotensin Receptor Blocker Use and Cardiovascular Outcomes Compared With Angiotensin-Converting Enzyme Inhibitors in Patients With Atherosclerotic Cardiovascular Disease: A Real-World Cohort Study

Q: What are the key findings of this study?

Angiotensin receptor blocker use was associated with a lower 1-year incidence of MACE compared with ACEI use (7.0% vs 8.6%; HR 0.77; 95% CI 0.76-0.78; P<.001).

Q: What does this research mean for the field?

In patients with atherosclerotic cardiovascular disease, the use of angiotensin receptor blockers is associated with a lower short-term risk of major adverse cardiovascular events compared to angiotensin-converting enzyme inhibitors, though this may reflect differences in treatment patterns rather than intrinsic pharmacologic superiority. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

The aim is to evaluate the association of ARB and ACEI use with cardiovascular outcomes in ASCVD patients.

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Why the study?

Does angiotensin receptor blocker (ARB) use reduce 1-year major adverse cardiovascular events in adults with established ASCVD compared with angiotensin-converting enzyme inhibitor (ACEI) use?

Population

1,203,920 adults (≥18 years) with established atherosclerotic cardiovascular disease (ASCVD)

Comparison

Angiotensin receptor blocker (ARB) vs Angiotensin-converting enzyme inhibitor (ACEI)

Design

Cohort

Follow-up

1 year

Key result

Angiotensin receptor blocker use was associated with a lower 1-year incidence of MACE compared with ACEI use (7.0% vs 8.6%; HR 0.77; 95% CI 0.76-0.78; P<.001).

Authors

JWJheng-Yan Wu KLKeng-Wei Lee SHS H. M. Huang

Discussion

Member takes

Overview

ARB use was associated with lower MACE risk than ACEI; extends observational data but leaves open need for RCTs.

Key Points

The aim is to evaluate the association of ARB and ACEI use with cardiovascular outcomes in ASCVD patients.
Retrospective cohort study using TriNetX network
Included adults with ASCVD from Jan 2002 to Aug 2025
Performed propensity score matching to balance demographics and clinical data.
ARB users had a lower 1-year incidence of MACE at 7.0% compared to 8.6% for ACEI users (HR 0.77, 95% CI 0.76-0.78, P<0.001).
ARB use was associated with reduced risks of ischemic stroke (HR 0.76, 95% CI 0.75-0.78) and myocardial infarction (HR 0.85, 95% CI 0.83-0.87).
All-cause mortality risk was lower in ARB users (HR 0.73, 95% CI 0.72-0.74).

Study Design

Type

Cohort (n=1,203,920)

Multicenter

Yes

Structured PICO

Does angiotensin receptor blocker (ARB) use reduce 1-year major adverse cardiovascular events in adults with established ASCVD compared with angiotensin-converting enzyme inhibitor (ACEI) use?

Population

1,203,920 adults with established atherosclerotic cardiovascular disease comparing ARB vs ACEI use, followed for 1 year.

Exposure

Angiotensin receptor blocker (ARB)

Comparator

Angiotensin-converting enzyme inhibitor (ACEI)

Outcome

1-year major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, or all-cause mortality)composite

Main Result

Hazard Ratio: 0.77 (95% CI 0.76–0.78)

Absolute Event Rate: 7% vs 8.6%

p-value: p=<.001

Real-world data suggests ARB use is associated with a lower 1-year risk of MACE compared to ACEI use in ASCVD patients, though residual confounding cannot be ruled out.

Limitations

Findings should be interpreted as non-causal and may reflect differences in treatment patterns, adherence, and patient characteristics rather than intrinsic pharmacologic superiority.
Findings should be interpreted as non-causal
May reflect differences in treatment patterns, adherence, and patient characteristics rather than intrinsic pharmacologic superiority

Cite This Study

Wu et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=1,203,920). Angiotensin receptor blocker (ARB) vs. Angiotensin-converting enzyme inhibitor (ACEI) was evaluated on 1-year major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, or all-cause mortality) (HR 0.77, 95% CI 0.76-0.78, p=<.001). Angiotensin receptor blocker use was associated with a lower 1-year incidence of MACE compared with ACEI use (7.0% vs 8.6%; HR 0.77; 95% CI 0.76-0.78; P<.001).

synapsesocial.com/papers/6a3724bb01fe431c251889ef https://doi.org/10.1016/j.mayocp.2026.05.016

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June 20, 2026Mayo Clinic Proceedings

Association Between Angiotensin Receptor Blocker Use and Cardiovascular Outcomes Compared With Angiotensin-Converting Enzyme Inhibitors in Patients With Atherosclerotic Cardiovascular Disease: A Real-World Cohort Study

View Full Paper

Ask AI

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Why the study?

Does angiotensin receptor blocker (ARB) use reduce 1-year major adverse cardiovascular events in adults with established ASCVD compared with angiotensin-converting enzyme inhibitor (ACEI) use?

Population

1,203,920 adults (≥18 years) with established atherosclerotic cardiovascular disease (ASCVD)

Comparison

Angiotensin receptor blocker (ARB) vs Angiotensin-converting enzyme inhibitor (ACEI)

Design

Cohort

Follow-up

1 year

Key result

Angiotensin receptor blocker use was associated with a lower 1-year incidence of MACE compared with ACEI use (7.0% vs 8.6%; HR 0.77; 95% CI 0.76-0.78; P<.001).

Authors

JWJheng-Yan Wu KLKeng-Wei Lee SHS H. M. Huang

Discussion

Member takes

Overview

ARB use was associated with lower MACE risk than ACEI; extends observational data but leaves open need for RCTs.

Key Points

The aim is to evaluate the association of ARB and ACEI use with cardiovascular outcomes in ASCVD patients.
Retrospective cohort study using TriNetX network
Included adults with ASCVD from Jan 2002 to Aug 2025
Performed propensity score matching to balance demographics and clinical data.
ARB users had a lower 1-year incidence of MACE at 7.0% compared to 8.6% for ACEI users (HR 0.77, 95% CI 0.76-0.78, P<0.001).
ARB use was associated with reduced risks of ischemic stroke (HR 0.76, 95% CI 0.75-0.78) and myocardial infarction (HR 0.85, 95% CI 0.83-0.87).
All-cause mortality risk was lower in ARB users (HR 0.73, 95% CI 0.72-0.74).

Study Design

Type

Cohort (n=1,203,920)

Multicenter

Yes

Structured PICO

Does angiotensin receptor blocker (ARB) use reduce 1-year major adverse cardiovascular events in adults with established ASCVD compared with angiotensin-converting enzyme inhibitor (ACEI) use?

Population

1,203,920 adults with established atherosclerotic cardiovascular disease comparing ARB vs ACEI use, followed for 1 year.

Exposure

Angiotensin receptor blocker (ARB)

Comparator

Angiotensin-converting enzyme inhibitor (ACEI)

Outcome

1-year major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, or all-cause mortality)composite

Main Result

Hazard Ratio: 0.77 (95% CI 0.76–0.78)

Absolute Event Rate: 7% vs 8.6%

p-value: p=<.001

Real-world data suggests ARB use is associated with a lower 1-year risk of MACE compared to ACEI use in ASCVD patients, though residual confounding cannot be ruled out.

Limitations

Findings should be interpreted as non-causal and may reflect differences in treatment patterns, adherence, and patient characteristics rather than intrinsic pharmacologic superiority.
Findings should be interpreted as non-causal
May reflect differences in treatment patterns, adherence, and patient characteristics rather than intrinsic pharmacologic superiority

Cite This Study

synapsesocial.com/papers/6a3724bb01fe431c251889ef https://doi.org/10.1016/j.mayocp.2026.05.016

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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