Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study
Authors' conclusion
Among older patients with T2DM, the initiation of ACEIs was associated with a trend toward lower risk of MACE compared to ARBs, implying the potential cardiovascular benefits of ACEIs in this population.
Study context
- Population
- Older patients (age ≥65 years) with T2D newly exposed to angiotensin-converting enzyme inhibitors (ACEIs) or ARBs, Yinzhou Regional Health Care Database, 2010–2023; median age 72 years, 45% male
- Participants
- 18,558 patients
- Comparison
- ACEIs vs ARBs
- ACEIsn = 1,641
- ARBsn = 16,917reference
- Outcome
- 3-point major cardiovascular events (MACE): hospitalized MI, hospitalized stroke and all-cause mortality (proxy for cardiovascular mortality)
Methodological detailsactive-comparator new-user design, propensity score, marginal structural models, per-protocol
- Active-comparator new-user design
- Propensity score
- Marginal structural models
- Per-protocol
Main finding
As reported in the abstract
3-point MACE
Adjusted hazard ratio (95% CI)
ACEIsvs ARBsper-protocol
0.86(0.68–1.10)
- Between ACEIs and ARBs
- 1-year absolute risk difference - 0.30% (95% CI - 1.80-1.21%)
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| 4-point MACE (adding hospitalized HF)ACEIsvs ARBs | 0.83 (0.69–0.99) | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | 1-year absolute risk difference (95% CI) |
|---|---|
| 4-point MACE (adding hospitalized HF)Between ACEIs and ARBs | - 1.16% (- 2.97-0.66%) |
Subgroup and sensitivity analyses
- Results consistent across subgroups (age, sex, baseline atherosclerotic CVD, HF, other antihypertensives, insulin, calendar year) and sensitivity analyses
Original publication
Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study. Cardiovasc Diabetol. Published 6 May 2025. doi:10.
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