Angiotensin‐converting enzyme inhibitors prevent... : Hepatology (original) (raw)

ORIGINAL ARTICLES: STEATOHEPATITIS

Angiotensin‐converting enzyme inhibitors prevent liver‐related events in nonalcoholic fatty liver disease

Zhang, Xinrong1,2,3; Wong, Grace Lai‐Hung1,2,3; Yip, Terry Cheuk‐Fung1,2,3; Tse, Yee‐Kit1,2,3; Liang, Lilian Yan1,2,3; Hui, Vicki Wing‐Ki1,2,3; Lin, Huapeng1,2,3; Li, Guan‐Lin1,2,3; Lai, Jimmy Che‐To1,2,3; Chan, Henry Lik‐Yuen2,4; Wong, Vincent Wai‐Sun*,1,2,3

1Department of Medicine and TherapeuticsPrince of Wales HospitalShatinHong Kong

2Medical Data Analytic Centre (MDAC)The Chinese University of Hong KongShatinHong Kong

3Institute of Digestive DiseaseFaculty of MedicineThe Chinese University of Hong KongShatinHong Kong

4Union HospitalHong Kong SARChina

* Correspondence
Vincent Wai‐Sun Wong, Department of Medicine and Therapeutics 9/F, Clinical Sciences Building, Prince of Wales Hospital, 30‐32 Ngan Shing Street, Shatin, Hong Kong.
Email: [email protected]

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Abstract

Background and Aims

Angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis in animal models. We aimed to evaluate the impact of ACEI/ARB use on the risk of liver cancer and cirrhosis complications in patients with NAFLD.

Approach and Results

We conducted a retrospective, territory‐wide cohort study of adult patients with NAFLD diagnosed between January 2000 and December 2014 to allow for at least 5 years of follow‐up. ACEI or ARB users were defined as patients who had received ACEI or ARB treatment for at least 6 months. The primary endpoint was liver‐related events (LREs), defined as a composite endpoint of liver cancer and cirrhosis complications. We analyzed data from 12,327 NAFLD patients (mean age, 54.2 ± 14.7 years; 6163 men [50.0%]); 6805 received ACEIs, and 2877 received ARBs. After propensity score weighting, ACEI treatment was associated with a lower risk of LREs (weighted subdistribution hazard ratio [SHR], 0.48; 95% CI, 0.35–0.66; p < 0.001), liver cancer (weighted SHR, 0.46; 95% CI, 0.28–0.75; p = 0.002), and cirrhosis complications (weighted SHR, 0.42; 95% CI, 0.27–0.66; p < 0.001), but ARB was not. In subgroup analysis, ACEI treatment was associated with greater reduction in LREs in patients with chronic kidney diseases (CKDs) than those without (CKD‐weighted SHR, 0.74; 95% CI, 0.52–0.96; p = 0.036; non‐CKD‐weighted SHR, 0.15; 95% CI, 0.07–0.33; p < 0.001).

Conclusions

ACEI, rather than ARB, treatment is associated with a lower risk of LREs in NAFLD patients, especially among those with CKD.