Objective To compare the effectiveness and safety of angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) for coronary heart disease (CHD). Methods Randomized controlled trials (RCTs) on ARB vs. ACEI in treating CHD were collected in databases including MEDLINE, EMbase, BIOSIS Previews, The Cochrane Library, CBM, VIP, WanFang Data and CNKI from inception to July 2011, and the references of the included articles were also retrieved. In accordance with the Cochrane Handbook 5.0.1, two reviewers independently evaluated the quality of articles, and extracted and cross-checked the data. Then meta-analysis was performed using RevMan 5.1.1 software. Results A total of 18 RCTs (17 660 cases) were included. The results of meta-analysis showed that there were no significant differences between the ARB group and the ACEI group in all-cause mortality (RR=1.04, 95%CI 0.98 to 1.11, P=0.20), cardiovascular mortality (RR=1.04, 95%CI 0.97 to 1.12, P=0.26), myocardial infarction (RR=0.98, 95%CI 0.92 to 1.05, P=0.59), hospitalization for heart failure (RR=1.14, 95%CI 0.97 to 1.32, P=0.11) and stroke (RR=0.93, 95%CI 0.80 to 1.08, P=0.34). However, the risk of adverse events causing drug discontinuation was significantly lower in the ARB group compared with the ACEI group (RR=0.77, 95%CI 0.67 to 0.89, P=0.000 3). Conclusion Current evidence suggests that ARB is as effective as ACEI in reducing the risk of all-cause mortality, cardiovascular mortality, myocardial infarction, hospitalization for heart failure and stroke in patients with coronary heart disease. Moreover, it is much better in tolerance. Because of the quality limitation and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective clinical trials.
Objective To synthesize the available evidence on the efficacy of using statins in the prevention of recurrent and new-onset atrial fibrillation (AF). Methods We searched PubMed, EMbase, EMB Reviews-Cochrane Central Register of Controlled Trials (Issue 3, 2007), CBMdisc, VIP, and CNKI databases from establishment to 15th Sep. 2007 to identify randomized controlled trials (RCTs) covering the use of statins for the patients with persistent AF after electrical cardioversion, paroxysmal and postoperative AF. Meta-analysis was performed using RevMan 4.3 software after the strict evaluation of the methodological quality of the included RCTs. Results Five RCTs including 470 patients were included. Significant heterogeneity was found when the data were pooled, so a random effect model was used for metaanalysis. Compared with placebo or no use of statins, the statins decreased risk of AF recurrence and postoperative AF (RR=0.61, 95%CI 0.43 to 0.88, P=0.008). Sensitivity analysis showed that the result was stable. The fail-safe number was 52.91. Conclusion The statins may decrease incidence of AF recurrence and postoperative AF. Because of the low quality and the small number of included studies, larger sample-size, randomized, double-blinded controlled trials are needed.