Skip to content
2000
  1. Home
  2. A-Z Publications
  3. Current Cardiology Reviews
  4. Volume 21, Issue 1
  5. Article
Volume 21, Issue 1
  • ISSN: 1573-403X
  • E-ISSN: 1875-6557

Abstract

Background

Atrial fibrillation (AFib) is a highly prevalent cardiac arrhythmia associated with increased mortality in affected persons. Renin-angiotensin system inhibitors (RASIs) have been suggested as potential therapeutic agents for cardiovascular and renal diseases.

Objectives

However, the relationship between RASIs and mortality in AFib patients remains uncertain. Therefore, the present study was designed and implemented for this purpose.

Methods

We searched PubMed/MEDLINE, Embase, Web of Science (WOS), Cochrane Library, and Scopus databases for studies published until 12 February 2024 with relevant keywords. We included studies that reported mortality outcomes in AFib patients treated with RASIs and non-users. The data extraction and quality assessment processes were conducted, and subgroup analyses and sensitivity analyses were done. The data were analyzed by Stata 15 using statistical tests, such as Chi-square and I2 tests.

Results

A total of 15 studies (2007-2024; n=2,178,565 patients) examined the association between RASI drugs and mortality of patients with AFib. The results indicated that compared to the control group, the odds of AFib mortality in the group receiving RASIs were equal to 0.81(95% CI: 0.71-0.92; value ≤0.001). The study results did not indicate publication bias (value=0.733). During the meta-regression analysis, none of the study variables demonstrated a significant relationship with the observed heterogeneity (value > 0.20). Cumulative OR results showed that from 2022 onwards, there was enough evidence to confirm the relationship using RASIs with mortality of patients with AFib.

Conclusion

Therefore, this meta-analysis suggests that the use of RASI drugs is associated with reduced AFib mortality. However, the authors emphasize the need for further high-quality studies and large-scale randomized clinical trials to validate these findings.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/ccr/10.2174/011573403X326428240902114410
2024-09-16
2025-05-23

  • From This Site

    /content/journals/ccr/10.2174/011573403X326428240902114410
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. KavousiM. Differences in epidemiology and risk factors for atrial fibrillation between women and men.Front. Cardiovasc. Med.20207310.3389/fcvm.2020.00003 32118043
     [Google Scholar]
  2. NesheiwatZ. GoyalA. JagtapM. Atrial Fibrillation.Treasure Island, FLStatPearls Publishing2024
     [Google Scholar]
  3. KornejJ. BörschelC.S. BenjaminE.J. SchnabelR.B. Epidemiology of atrial fibrillation in the 21st Century.Circ. Res.2020127142010.1161/CIRCRESAHA.120.316340 32716709
     [Google Scholar]
  4. RushK.L. SeatonC.L. BurtonL. Quality of life among patients with atrial fibrillation: A theoretically-guided cross-sectional study.PLoS One20231810e029157510.1371/journal.pone.0291575 37797044
     [Google Scholar]
  5. RienstraM. LubitzS.A. MahidaS. Symptoms and functional status of patients with atrial fibrillation: State of the art and future research opportunities.Circulation2012125232933294310.1161/CIRCULATIONAHA.111.069450 22689930
     [Google Scholar]
  6. MattiaA NewmanJ ManettaF Treatment complications of atrial fibrillation and their management. Int J Angiol 202029209810710.1055/s‑0039‑340179432476810
    [Google Scholar]
  7. YooY.C. YounY.N. ShimJ.K. KimJ.C. KimN.Y. KwakY.L. Effects of renin-angiotensin system inhibitors on the occurrence of acute kidney injury following off-pump coronary artery bypass grafting.Circ. J.20107491852185810.1253/circj.CJ‑10‑0261 20631451
     [Google Scholar]
  8. LiE.C.K. HeranB.S. WrightJ.M. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension.Cochrane Libr.201420148CD00909610.1002/14651858.CD009096.pub2 25148386
     [Google Scholar]
  9. HerA.Y. ChoiB.G. RhaS.W. KimY.H. ChoiC.U. JeongM.H. The impact of angiotensin-converting-enzyme inhibitors versus angiotensin receptor blockers on 3-year clinical outcomes in patients with acute myocardial infarction without hypertension.PLoS One20201511e024231410.1371/journal.pone.0242314 33253206
     [Google Scholar]
  10. TurnerJ.M. KodaliR. Should angiotensin-converting enzyme inhibitors ever be used for the management of hypertension?Curr. Cardiol. Rep.20202299510.1007/s11886‑020‑01352‑8 32648000
     [Google Scholar]
  11. JiaQ. HanW. ShiS. HuY. The effects of ACEI/ARB, aldosterone receptor antagonists and statins on preventing recurrence of atrial fibrillation.Medicine (Baltimore)20211001e2428010.1097/MD.0000000000024280 33429839
     [Google Scholar]
  12. ChaugaiS. SherpaL.Y. SepehryA.A. ArimaH. WangD.W. Effect of RAAS blockers on adverse clinical outcomes in high CVD risk subjects with atrial fibrillation.Medicine (Baltimore)20169526e405910.1097/MD.0000000000004059 27368043
     [Google Scholar]
  13. ChenS. AcouW.J. KiuchiM.G. Association of preoperative renin-angiotensin system inhibitors with prevention of postoperative atrial fibrillation and adverse events.JAMA Netw. Open201925e19493410.1001/jamanetworkopen.2019.4934 31150082
     [Google Scholar]
  14. ChinJ.H. MoonY.J. JoJ.Y. Association between postoperatively developed atrial fibrillation and long-term mortality after esophagectomy in esophageal cancer patients: An observational study.PLoS One2016115e015493110.1371/journal.pone.0154931 27148877
     [Google Scholar]
  15. SezaiA. IidaM. YoshitakeI. Carperitide and atrial fibrillation after coronary bypass grafting: The Nihon University working group study of low-dose HANP infusion therapy during cardiac surgery trial for postoperative atrial fibrillation.Circ. Arrhythm. Electrophysiol.20158354655310.1161/CIRCEP.113.001211 25840580
     [Google Scholar]
  16. PetersonJ. WelchV. LososM. TugwellP. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.OttawaOttawa Hospital Research Institute2011112
     [Google Scholar]
  17. KjaergardL.L. VillumsenJ. GluudC. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses.Ann. Intern. Med.20011351198298910.7326/0003‑4819‑135‑11‑200112040‑00010 11730399
     [Google Scholar]
  18. JadadA.R. MooreR.A. CarrollD. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Control. Clin. Trials199617111210.1016/0197‑2456(95)00134‑4 8721797
     [Google Scholar]
  19. BelluzziF. SernesiL. CentolaM. PerliniS. Role of ACE-inhibitors in preventing atrial fibrillation relapses in normotensive patientsRecenti Prog. Med.200910011508511 20066882
     [Google Scholar]
  20. OgerE. KerbratS. NowakE. PaillardF. ScarabinP.Y. HappeA. Effectiveness of angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers on total and cardiovascular mortality and morbidity in primary prevention: A nationwide study based on French Health Insurance Data (SNDS).J. Clin. Hypertens. (Greenwich)202224443844810.1111/jch.14445 35229448
     [Google Scholar]
  21. HarjaiK.J. SolisS. PrasadA. LoupeJ. Use of aspirin in conjunction with angiotensin-converting enzyme inhibitors does not worsen long-term survival in heart failure.Int. J. Cardiol.2003882-320721410.1016/S0167‑5273(02)00401‑1 12714200
     [Google Scholar]
  22. PizzettiF. TurazzaF.M. FranzosiM.G. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: The GISSI-3 data.Br. Heart J.200186552753210.1136/heart.86.5.527 11602545
     [Google Scholar]
  23. ZulianiG. CherubiniA. VolpatoS. Treatment with angiotensin-converting enzyme inhibitors is associated with a reduction in short-term mortality in older patients with acute ischemic stroke.J. Gerontol. A Biol. Sci. Med. Sci.200560446346510.1093/gerona/60.4.463 15933384
     [Google Scholar]
  24. BertonG. CordianoR. CucchiniF. CavutoF. PellegrinetM. PalatiniP. Atrial fibrillation during acute myocardial infarction: Association with all-cause mortality and sudden death after 7-year of follow-up.Int. J. Clin. Pract.200963571272110.1111/j.1742‑1241.2009.02023.x 19392921
     [Google Scholar]
  25. BandealiS.J. KayaniW.T. LeeV.V. Outcomes of preoperative angiotensin-converting enzyme inhibitor therapy in patients undergoing isolated coronary artery bypass grafting.Am. J. Cardiol.2012110791992310.1016/j.amjcard.2012.05.021 22727178
     [Google Scholar]
  26. GigliL. AmeriP. SeccoG. Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure.World J. Cardiol.201681164765610.4330/wjc.v8.i11.647 27957251
     [Google Scholar]
  27. ProiettiM. RaparelliV. LarocheC. Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease: A report from the EURObservational research programme pilot survey on atrial fibrillation.Europace20171991439144810.1093/europace/euw169 27940934
     [Google Scholar]
  28. DesaiH. AronowW.S. AhnC. Risk factors for appropriate cardioverter-defibrillator shocks, inappropriate cardioverter-defibrillator shocks, and time to mortality in 549 patients with heart failure.Am. J. Cardiol.201010591336133810.1016/j.amjcard.2009.12.057 20403488
     [Google Scholar]
  29. ZhengJ.Y. CaoY. LiD.T. Predictive models for adverse clinical outcomes in Chinese patients with atrial fibrillation undergoing percutaneous coronary intervention with stenting.Acta Cardiol.202277436036510.1080/00015385.2021.1950367 34353224
     [Google Scholar]
  30. NguyenB.O. CrijnsH.J.G.M. TijssenJ.G.P. Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: Data of the RACE 3 trial.Europace202224691092010.1093/europace/euab270 34791160
     [Google Scholar]
  31. DönmezE. ÖzcanS. MertB. A retrospective study to evaluate the association between the glasgow prognostic score and atrial fibrillation, stroke, and mortality at 30 days and at 1 year after coronary artery bypass graft surgery.Med. Sci. Monit.202329e93928310.12659/MSM.939283 36718108
     [Google Scholar]
  32. MenichelliD. PoliD. AntonucciE. PalaretiG. PignatelliP. PastoriD. Renin‐angiotensin-aldosterone system inhibitors and mortality risk in elderly patients with atrial fibrillation. Insights from the nationwide start registry.Eur. J. Intern. Med.2024119849210.1016/j.ejim.2023.08.019 37648584
     [Google Scholar]
  33. StevensonW.G. StevensonL.W. MiddlekauffH.R. Improving survival for patients with atrial fibrillation and advanced heart failure.J. Am. Coll. Cardiol.19962861458146310.1016/S0735‑1097(96)00358‑0 8917258
     [Google Scholar]
  34. RichterB. DerntlM. MarxM. LercherP. GössingerH.D. Therapy with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins: No effect on ablation outcome after ablation of atrial fibrillation.Am. Heart J.2007153111311910.1016/j.ahj.2006.09.006 17174648
     [Google Scholar]
  35. BarywaniS. PetzoldM. Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation.Scand. Cardiovasc. J.201751419019610.1080/14017431.2017.1314549 28393567
     [Google Scholar]
  36. NieuwlaatR. EurlingsL.W. ClelandJ.G. Atrial fibrillation and heart failure in cardiology practice: Reciprocal impact and combined management from the perspective of atrial fibrillation: Results of the Euro Heart Survey on atrial fibrillation.J. Am. Coll. Cardiol.200953181690169810.1016/j.jacc.2009.01.055 19406345
     [Google Scholar]
  37. MiceliA. CapounR. FinoC. Effects of angiotensin-converting enzyme inhibitor therapy on clinical outcome in patients undergoing coronary artery bypass grafting.J. Am. Coll. Cardiol.200954191778178410.1016/j.jacc.2009.07.008 19682819
     [Google Scholar]
  38. LipG.Y.H. FrisonL. GrindM. Angiotensin converting enzyme inhibitor and angiotensin receptor blockade use in relation to outcomes in anticoagulated patients with atrial fibrillation.J. Intern. Med.2007261657758610.1111/j.1365‑2796.2007.01780.x 17547713
     [Google Scholar]
  39. ZhengB. KangJ. TianY. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers have no beneficial effect on ablation outcome in chronic persistent atrial fibrillation.Acta Cardiol.200964333534010.2143/AC.64.3.2038018 19593943
     [Google Scholar]
  40. RaderF. Van WagonerD.R. GillinovA.M. BlackstoneE.H. Preoperative angiotensin-blocking drug therapy is not associated with atrial fibrillation after cardiac surgery.Am. Heart J.20101602329336.e110.1016/j.ahj.2010.05.033 20691840
     [Google Scholar]
  41. BarodkaV. SilvestryS. ZhaoN. Preoperative renin-angiotensin system inhibitors protect renal function in aging patients undergoing cardiac surgery.J. Surg. Res.20111672e63e6910.1016/j.jss.2009.11.702 20189597
     [Google Scholar]
  42. RadaelliG. BodaneseL.C. GuaragnaJ.C. The use of inhibitors of angiotensin-converting enzyme and its relation to events in the postoperative period of CABG.Rev. Bras. Cir. Cardiovasc.201126337337910.5935/1678‑9741.20110011 22086573
     [Google Scholar]
  43. PretoriusM. MurrayK.T. YuC. Angiotensin-converting enzyme inhibition or mineralocorticoid receptor blockade do not affect prevalence of atrial fibrillation in patients undergoing cardiac surgery.Crit. Care Med.201240102805281210.1097/CCM.0b013e31825b8be2 22824930
     [Google Scholar]
  44. BatraG. LindhagenL. AndellP. Angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers are associated with improved outcome but do not prevent new‐onset atrial fibrillation after acute myocardial infarction.J. Am. Heart Assoc.201763e00516510.1161/JAHA.116.005165 28320744
     [Google Scholar]
  45. LyuS.Q. YangY.M. ZhuJ. Effects of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker on one-year outcomes of patients with atrial fibrillation: Insights from a multicenter registry study in China.J. Geriatr. Cardiol.2020171275075810.11909/j.issn.1671‑5411.2020.12.005 33424942
     [Google Scholar]
  46. Cespón-FernándezM. Raposeiras-RoubínS. Abu-AssiE. Melendo-ViuM. García-CampoE. Íñiguez-RomoA. Renin-angiotensin system inhibitors prognostic benefit in older patients with atrial fibrillation.J. Am. Med. Dir. Assoc.202122102190219510.1016/j.jamda.2021.01.063 33607060
     [Google Scholar]
  47. LiuC. LaiY. WuD. Impact of renin‐angiotensin system inhibitors on long‐term clinical outcomes of patients with rheumatic heart disease.ESC Heart Fail.2021865338535110.1002/ehf2.13623 34545695
     [Google Scholar]
  48. XuW. YangY. ZhuJ. Impact of renin–angiotensin–aldosterone-system inhibitor drugs on mortality in patients with atrial fibrillation and hypertension.BMC Cardiovasc. Disord.202222114110.1186/s12872‑022‑02580‑2 35365067
     [Google Scholar]
  49. ParkC.S. KimB. RheeT.M. Association between renin–angiotensin–aldosterone system blockade and clinical outcomes in patients with hypertension: Real-world observation from a nationwide hypertension cohort.Clin. Res. Cardiol.2023112111577158610.1007/s00392‑023‑02179‑3 36867200
     [Google Scholar]
  50. AlrabadiN. Al-NusairM. HaddadR. Cardiovascular medications used for comorbid diseases in patients with atrial fibrillation. The JoFib study.Eur. J. Clin. Pharmacol.202480454555210.1007/s00228‑024‑03622‑8 38253701
     [Google Scholar]
  51. ZografosT. KatritsisD.G. Inhibition of the renin-angiotensin system for prevention of atrial fibrillation.Pacing Clin. Electrophysiol.201033101270128510.1111/j.1540‑8159.2010.02832.x 20636314
     [Google Scholar]
  52. MaH. JiangH. FengJ. GanY. Angiotensin receptor blocker and calcium channel blocker preventing atrial fibrillation recurrence in patients with hypertension and atrial fibrillation: A meta-analysis.Cardiovasc. Ther.202120211810.1155/2021/6628469 34104205
     [Google Scholar]
  53. LiS. WangJ. YanY. GongW. NieS. Angiotensin-converting enzyme inhibitors decrease the risk of cardiac rupture after acute myocardial infarction: A Meta-analysis of randomized controlled trials.Cardiovasc. Innov. Appl.20238110.15212/CVIA.2023.0040
     [Google Scholar]
  54. CliffB. YounisN. HamaS. SoranH. The role of the renin–angiotensin system blocking in the management of atrial fibrillation.J. Drug Assess.201211556410.3109/21556660.2012.672353 27536429
     [Google Scholar]
  55. MascoloA. UrbanekK. De AngelisA. Angiotensin II and angiotensin 1–7: Which is their role in atrial fibrillation?Heart Fail. Rev.202025236738010.1007/s10741‑019‑09837‑7 31375968
     [Google Scholar]
  56. LimpitikulW.B. DasS. Obesity-Related Atrial Fibrillation: Cardiac Manifestation of a Systemic Disease.J. Cardiovasc. Dev. Dis.202310832310.3390/jcdd10080323 37623336
     [Google Scholar]
  57. LeventopoulosG. KorosR. TravlosC. Mechanisms of Atrial Fibrillation: How Our Knowledge Affects Clinical Practice.Life (Basel)2023136126010.3390/life13061260 37374043
     [Google Scholar]
  58. QianY. FeiZ. NianF. The association between rheumatoid arthritis and atrial fibrillation: Epidemiology, pathophysiology and management.Int. J. Gen. Med.2023161899190810.2147/IJGM.S406926 37223618
     [Google Scholar]
  59. NairG.M. NeryP.B. RedpathC.J. BirnieD.H. The role of renin angiotensin system in atrial fibrillation.J. Atr. Fibrillation20146697210.4022/jafib.972 27957054
     [Google Scholar]
  60. MangieriA. Renin-angiotensin system blockers in cardiac surgery.J. Crit. Care201530361361810.1016/j.jcrc.2015.02.017 25813547
     [Google Scholar]
/content/journals/ccr/10.2174/011573403X326428240902114410
Loading
The Relationship between Using Renin-Angiotensin System Inhibitors with Mortality of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Curr. Cardiol. Rev. 21, E1573403X326428 (2025); https://doi.org/10.2174/011573403X326428240902114410
/content/journals/ccr/10.2174/011573403X326428240902114410
/content/journals/ccr/10.2174/011573403X326428240902114410
Loading

Data & Media loading...

Supplements

PRISMA checklist as Supplementary material is available on the publishers' website along with the published article.

file format download Download

  • Article Type:     Research Article
Keyword(s): angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; atrial fibrillation; chi-square; mortality; Renin-angiotensin system inhibitors

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test