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Clinical predictors of ACE-inhibitor induced dry cough in 27492 patients with cardiovascular disease using individual data of randomized clinical trials

Session Poster Session 5

Speaker Jasper Brugts

Event : ESC Congress 2013

  • Topic : preventive cardiology
  • Sub-topic : Cardiovascular Rehabilitation
  • Session type : Poster Session

Authors : J J Brugts (Rotterdam,NL), H Arima (Sydney,AU), M Bertrand (Lille,FR), R Ferrari (Ferrara,IT), K Fox (London,GB), M Simoons (Rotterdam,NL), J Chalmers (Sydney,AU), JJ Mourad (Paris,FR), E Boersma (Rotterdam,NL), KM Akkerhuis (Rotterdam,NL)

J.J. Brugts1 , H. Arima2 , M. Bertrand3 , R. Ferrari4 , K. Fox5 , M. Simoons1 , J. Chalmers6 , J.J. Mourad7 , E. Boersma1 , K.M. Akkerhuis1 , 1Erasmus Medical Center - Rotterdam - Netherlands , 2University of Sydney - Sydney - Australia , 3Hospital Regional University of Lille - Cardiological Hospital - Lille - France , 4University of Ferrara, S. Anna Hospital - Ferrara - Italy , 5Royal Brompton National Heart & Lung Hospital - London - United Kingdom , 6Royal Prince Alfred Hospital - Sydney - Australia , 7University Paris 13 - Paris - France ,

On behalf: EUROPA, ADVANCE and PROGRESS trialists

European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 798-799

Purpose: To investigate the incidence and clinical predictors of dry cough in patients treated with ACE-inhibitors. Dry cough is a frequent reason to stop ACE-inhibitor treatment.

Methods: We studied 27.492 ACE-inhibitor naïve patients randomized to ACE-inhibitor or placebo for the incidence of dry cough using individual data of 3 large randomized placebo controlled trials (EUROPA, PROGRESS and ADVANCE). Multivariate regression analysis was used to study the incidence of cough in relation to baseline clinical characteristics including racial background.

Results: In 27.492 patients with cardiovascular disease, 1076 patients discontinued ACE-inhibitor treatment due to cough (3.9%), 703 patients during run-in period of 4 weeks (2.6%, short-term cough) and 373 patients during a mean follow-up of four years (3.1%, long-term cough). During follow-up, 96 patients experienced cough in the placebo group (0.8%). Significant determinants of cough were female gender (OR 1.92 95% CI 1.68-2.18); age above 65 years (OR 1.53 95% CI 1.35-1.73) and statin use (OR 1.37; 95% CI 1.18-1.59). A clinical risk score composed of these 3 predictors of cough is shown in figure 1, the highest risk score 3 mounted to an odds ratio of 4.4 (95% CI 3.1-5.4). Racial background was not related to a differential incidence of cough in Caucasian or Asian descendent patients (OR 1.11 95% CI 0.92-1.39). No difference was found in determinants of short-term versus long-term ACE-inhibitor related cough.

Conclusion: This large analysis of 3 clinical trials in 27.492 patients shows an overall lower incidence of ACE-inhibitor induced cough (3.9%) as compared to literature. The highest incidence of cough was seen especially in female patients at older age. In contrast, racial differences were not related to the incidence of dry cough.

Figure 1

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