{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T01:44:46Z","timestamp":1773279886954,"version":"3.50.1"},"reference-count":48,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,10,21]],"date-time":"2018-10-21T00:00:00Z","timestamp":1540080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003621","name":"Ministry of Science, ICT and Future Planning","doi-asserted-by":"publisher","award":["2013M3A9B5075838"],"award-info":[{"award-number":["2013M3A9B5075838"]}],"id":[{"id":"10.13039\/501100003621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2018,11]]},"abstract":"Study Objective<\/jats:title>Patients with coronary heart disease (CHD<\/jats:styled-content>) frequently use the combination of a statin and renin\u2010angiotensin\u2010aldosterone system (RAAS<\/jats:styled-content>) blocker, an angiotensin\u2010converting enzyme inhibitor (ACEI<\/jats:styled-content>) or angiotensin II<\/jats:styled-content> receptor blocker (ARB<\/jats:styled-content>), to control lipid levels and blood pressure, respectively, and the use of ARB<\/jats:styled-content>s is increasing in Korean patients. Few studies are available, however, that have compared combination therapy with statin\u2010ACEI<\/jats:styled-content>s versus statin\u2010ARB<\/jats:styled-content>s. The objective of this study was to evaluate whether ARB<\/jats:styled-content>s are associated with a reduced risk of major adverse cardiovascular and cerebrovascular events (MACCE<\/jats:styled-content>s) compared with ACEI<\/jats:styled-content>s when used in combination with statins in patients with established CHD<\/jats:styled-content>.<\/jats:p><\/jats:sec>Design<\/jats:title>Population\u2010based retrospective cohort study.<\/jats:p><\/jats:sec>Data Source<\/jats:title>Korean National Health Insurance Service\u2013National Sample Cohort database.<\/jats:p><\/jats:sec>Patients<\/jats:title>A total of 6577 adults who started statin\u2010RAAS<\/jats:styled-content> blocker combination therapy (1870 in the statin\u2010ACEI<\/jats:styled-content> cohort and 4707 in the statin\u2010ARB<\/jats:styled-content> cohort) after being diagnosed with CHD<\/jats:styled-content> between January 2003 and December 2013 were included. Of these, 3676 propensity score\u2013matched patients (1838 in the statin\u2010ACEI<\/jats:styled-content> cohort and 1838 in the statin\u2010ARB<\/jats:styled-content> cohort) were included in the final analyses.<\/jats:p><\/jats:sec>Measurements and Main Results<\/jats:title>The primary outcome was MACCE (major adverse cardiovascular and cerebrovascular events), a composite of cardiovascular mortality, nonfatal myocardial infarction (MI)<\/jats:styled-content>, ischemic stroke, and revascularization. Incidences and incidence rates of MACCE<\/jats:styled-content> were calculated to estimate the differences between the two cohorts. Hazard ratios (HR<\/jats:styled-content>s) and 95% confidence intervals (CI<\/jats:styled-content>s) were estimated by using a Cox proportional hazard model. The incidence of MACCE<\/jats:styled-content> was 19.9% and 14.7%, and incidence rates were 11.7 and 8.1 per 100 person\u2010years in the statin\u2010ACEI<\/jats:styled-content> and statin\u2010ARB<\/jats:styled-content> cohorts, respectively. The risk of MACCE<\/jats:styled-content> was significantly lower in the statin\u2010ARB<\/jats:styled-content> cohort (adjusted HR<\/jats:styled-content> 0.69, 95% CI<\/jats:styled-content> 0.59\u20130.81).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>A MACCE<\/jats:styled-content> was less likely to occur in patients who received a statin\u2010ARB<\/jats:styled-content> than in those who received a statin\u2010ACEI<\/jats:styled-content>. Similar trends were seen in cardiovascular mortality and the occurrence of recurrent MI<\/jats:styled-content> but not stroke. The availability of statin\u2010ARB<\/jats:styled-content> fixed\u2010dose combinations may have contributed to the improved outcomes in the statin\u2010ARB<\/jats:styled-content> cohort by reducing pill burden and improving medication adherence. Further research is warranted to validate our findings and to address whether a particular statin\u2010ARB<\/jats:styled-content> combination is more effective than other combinations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2181","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T23:33:09Z","timestamp":1537227189000},"page":"1095-1105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparative Effectiveness of Combination Therapy with Statins and Angiotensin\u2010Converting Enzyme Inhibitors versus Angiotensin II<\/scp> Receptor Blockers in Patients with Coronary Heart Disease: A Nationwide Population\u2010Based Cohort Study in Korea"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5649-6530","authenticated-orcid":false,"given":"Jimin","family":"Lee","sequence":"first","affiliation":[{"name":"College of Pharmacy Ajou University Suwon South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8830-4353","authenticated-orcid":false,"given":"Sukhyang","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Pharmacy Ajou University Suwon South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,21]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Coronary Artery Disease (CAD). 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