Does Renin-Angiotensin System Blockade Protect Lupus Nephritis Patients From Atherosclerotic Cardiovascular Events? A Case-Control Study.

OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are used as an adjuvant treatment in lupus nephritis (LN) patients with proteinuria. The primary aim of this study was to discover whether ACE inhibitors/ARBs have an atheroprotective effect similar to other, at-risk, populations.

METHODS: A total of 144 patients (cases; mean ± SD age at onset 34 ± 12.1 years, followup 14.9 ± 8.6 years) with LN who were treated with ACE inhibitors/ARBs for at least 5 years were enrolled. The control group comprised 301 LN patients (mean ± SD age at onset 34.1 ± 13.2 years, followup 13.4 ± 7.9 years) with no such treatment. All patients were followed for the occurrence of atherosclerotic cardiovascular events (CVEs), consisting of transient ischemic attack and stroke, angina, myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), and congestive heart failure. Patients with preexisting CVEs were excluded.

RESULTS: There were no significant differences in the cumulative occurrence of CVEs (9.7% for treated versus 8.6% for nontreated patients; P = 0.708); however, hard events (stroke, myocardial infarction, CABG, and PTCA) were less frequent in treated patients (4.17% versus 5.32%). Cases were more frequently hypertensive (100% versus 52.8%; P < 0.001) and diabetic (10.4% versus 4.7%; P = 0.021), whereas controls more frequently had hypercholesterolemia (27.9% versus 18.1%; P = 0.024) and elevated triglycerides (14% versus 4.9%; P = 0.004); other variables did not differ significantly. Regression analysis failed to confirm ACE inhibitor/ARB nonuse as an important predictor of future CVEs.

CONCLUSION: Our data do not support the hypothesis that ACE inhibitors/ARBs may be protective against atherosclerotic CVEs in LN patients.