{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T01:19:50Z","timestamp":1793582390657,"version":"4.5.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,5,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Renin\u2010angiotensin system blockers (RASBs) have well\u2010validated benefit in patients with hypertension, coronary artery disease, and left ventricular systolic dysfunction. Their use in the perioperative period, however, has been controversial, including in patients undergoing cardiac surgery, who often have a strong indication for their use. In the current study, we explore the impact of RASB use with 30\u2010day and 1\u2010year mortality after cardiac surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The Veterans Affairs Surgical Quality Improvement Program and Corporate Data Warehouse were data sources for this retrospective cohort study. A total of 37\u00a0197 veterans undergoing elective coronary artery bypass grafting and or valve repair or replacement over a 10\u2010year period met inclusion criteria and were stratified into 4 groups by preoperative exposure (preoperative exposure versus no preoperative exposure) and postoperative continuing exposure (current exposure versus no current exposure) to RASBs. After adjusting for all baseline covariates, the preoperative exposure\/current exposure group had lower 30\u2010day and 1\u2010year mortality than the preoperative exposure\/no current exposure (30\u2010day hazard ratio [HR], 0.25; 95% CI, 0.19\u20130.33 [\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001] and 1\u2010year HR, 0.40; 95% CI, 0.33\u20130.48 [\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001] or no preoperative exposure\/no current exposure (30\u2010day HR, 0.44; 95% CI, 0.32\u20130.60 [\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001] and 1\u2010year HR, 0.72; 95% CI, 0.62\u20130.84 [\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001] groups. The no preoperative exposure\/current exposure group had significantly lower 30\u2010day (HR, 0.31; 95% CI, 0.14\u20130.71 [\n              <jats:italic>P<\/jats:italic>\n              =0.006]) and 1\u2010year (HR, 0.64; 95% CI, 0.53\u20130.77 [\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001]) mortality than the no preoperative exposure\/no current exposure group.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Continuation of preoperative RASBs and initiation before discharge is associated with decreased mortality in veterans undergoing cardiac surgery. Given these findings, continuation of preoperative RASBs or initiation in the early postoperative period should be considered in patients undergoing cardiac surgery.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019731","type":"journal-article","created":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T09:03:12Z","timestamp":1620464592000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of Renin\u2010Angiotensin System Blockers on Mortality in Veterans Undergoing Cardiac Surgery"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-1837","authenticated-orcid":false,"given":"Derrick T.","family":"Antoniak","sequence":"first","affiliation":[{"name":"Veterans Affairs Nebraska\u2010Western Iowa Health Care System Omaha NE"},{"name":"Division of General Internal Medicine Department of Medicine University of Nebraska Medical Center Omaha NE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8801-9886","authenticated-orcid":false,"given":"Ryan W.","family":"Walters","sequence":"additional","affiliation":[{"name":"Division of Clinical Research and Evaluative Sciences Department of Medicine Creighton University Omaha NE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9196-7238","authenticated-orcid":false,"given":"Venkata M.","family":"Alla","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine Creighton University Omaha NE"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.13766"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.10.824"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001404"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.04.018"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv023"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002837"},{"key":"e_1_3_1_10_2","first-page":"CD009210","article-title":"Perioperative angiotensin\u2010converting enzyme inhibitors or angiotensin II type 1 receptor blockers for preventing mortality and morbidity in adults","author":"Zou Z","year":"2016","unstructured":"Zou Z, Yuan HB, Yang B, Xu F, Chen XY, Liu GJ, Shi XY. 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