Improved survival and reduced alcohol-associated hepatitis risk with renin-angiotensin-aldosterone system inhibitors in alcohol-associated liver disease.
Alcohol-associated liver disease (ALD) is a leading cause of liver-related mortality and is increasingly recognized for its contribution to cardiovascular diseases. The renin-angiotensin-aldosterone system (RAAS), including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), has demonstrated benefits in modulating inflammatory pathways. Clinical data regarding the effects in patients with ALD remain limited.
We conducted a retrospective cohort study utilizing the TriNetX platform. Patients with ALD who were prescribed ACEI/ARB were compared with those prescribed calcium channel blockers (CCB). Propensity score matching (1:1) was applied to balance baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included alcohol-associated hepatitis (AH), major adverse cardiovascular events (MACE), major adverse liver outcomes (MALO), and sepsis. Patients were followed for 5 years. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).
After matching, 7884 patients were included (3942 per group). ACEI/ARB use was associated with a significantly lower risk of all-cause mortality (HR: 0.70, 95% CI: 0.64-0.78, p < 0.001) compared with CCB use. Furthermore, the ACEI/ARB cohort demonstrated significant risk reductions across all secondary outcomes, including MACE (HR: 0.69, 95% CI: 0.61-0.77, p < 0.001), MALO (HR: 0.81, 95% CI: 0.73-0.90, p < 0.001), AH (HR: 0.88, 95% CI: 0.80-0.97, p = 0.008), and sepsis (HR: 0.61, 95% CI: 0.53-0.70, p < 0.001).
In this large real-world cohort, ACEI/ARB use in patients with ALD was associated with reduced risks of mortality, cardiovascular events, liver events, AH, and sepsis, supporting a potential protective role of RAAS inhibition in ALD patients.
We conducted a retrospective cohort study utilizing the TriNetX platform. Patients with ALD who were prescribed ACEI/ARB were compared with those prescribed calcium channel blockers (CCB). Propensity score matching (1:1) was applied to balance baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included alcohol-associated hepatitis (AH), major adverse cardiovascular events (MACE), major adverse liver outcomes (MALO), and sepsis. Patients were followed for 5 years. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).
After matching, 7884 patients were included (3942 per group). ACEI/ARB use was associated with a significantly lower risk of all-cause mortality (HR: 0.70, 95% CI: 0.64-0.78, p < 0.001) compared with CCB use. Furthermore, the ACEI/ARB cohort demonstrated significant risk reductions across all secondary outcomes, including MACE (HR: 0.69, 95% CI: 0.61-0.77, p < 0.001), MALO (HR: 0.81, 95% CI: 0.73-0.90, p < 0.001), AH (HR: 0.88, 95% CI: 0.80-0.97, p = 0.008), and sepsis (HR: 0.61, 95% CI: 0.53-0.70, p < 0.001).
In this large real-world cohort, ACEI/ARB use in patients with ALD was associated with reduced risks of mortality, cardiovascular events, liver events, AH, and sepsis, supporting a potential protective role of RAAS inhibition in ALD patients.
Authors
Danpanichkul Danpanichkul, Pang Pang, Kim Kim, Ibrahim Ibrahim, Tothanarungroj Tothanarungroj, Al Ta'ani Al Ta'ani, Kulthamrongsri Kulthamrongsri, Duangsonk Duangsonk, Wong Wong, Huang Huang, Wijarnpreecha Wijarnpreecha, Noureddin Noureddin, Liangpunsakul Liangpunsakul
View on Pubmed