Evidence map›Paper›PMID 40329312›Full record

ArticleCardiovascular diabetology2025

Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study.

Weihong Zeng, Tiansheng Wang, Til Stürmer, Na He, Peng Shen, Hongbo Lin, Xiaodong Guan, Yang Xu

Abstract readComparative Study
In one paragraph

Article in Cardiovascular diabetology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
  4. Article
  5. Expanding the therapeutic frontier: esaxerenone in hypertensive patients with CKD and albuminuria.Hypertension research : official journal of the Japanese Society of Hypertension · 2025
    Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Weihong Zeng *Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
Tiansheng Wang *Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Til StürmerDepartment of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Na HeDepartment of Pharmacy, Peking University Third Hospital, Beijing, China.
Peng ShenDepartment of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China.
Hongbo LinDepartment of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China.
Xiaodong GuanDepartment of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Peking University, No.38 Xueyuan Road, Beijing, 100191, China.
Yang XuDepartment of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Peking University, No.38 Xueyuan Road, Beijing, 100191, China. xuyang_pucri@bjmu.edu.cn.

Funding

North Carolina Translational and Clinical Sciences Institute (NC TraCS)UM1TR004406 · NCATS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI NICHOLAS J SHAHEEN · 2023 to 2026
$37.5M
Pilot & Feasibility ProgramP30DK124723 · NIDDK · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI P Darrell Neufer · 2020 to 2026
$11.0M
American Diabetes Association 4-22-PDFPM-06Ministry of Science and Technology of the People's Republic of China 2021YFC2501300National Natural Science Foundation of China 82304245NCATS NIH HHS UM1 TR004406NIDDK NIH HHS P30 DK124723
6 · The paper itself

Abstract

backgroundAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are both recommended as first-line antihypertensive agents for patients with diabetes. While pharmacological mechanisms suggest that ACEIs may provide better cardiovascular protection than ARBs, this potential benefit has not been fully established in previous observational studies of patients with diabetes.

methodsAn active-comparator new-user design within target trial emulation framework was implemented using Yinzhou Regional Health Care Database (YRHCD). We compared risks of major cardiovascular events (MACE) between older patients (age ≥ 65 years) with type 2 diabetes mellitus (T2DM) newly exposed to ACEIs and ARBs from January 1, 2010 to May 31, 2023. The primary outcomes were 3-point MACE, including hospitalized myocardial infarction, hospitalized stroke, and all-cause mortality (a proxy for cardiovascular mortality). We also assessed 4-point MACE, which further included hospitalized heart failure. Propensity scores were calculated to balance 44 identified confounders. Marginal structure models were applied to estimate per-protocol hazard ratios.

resultsA total of 18,558 individuals were included, with 1,641 initiating ACEIs and 16,917 initiating ARBs. Their median age was 72 years and 45% were male. The adjusted hazard ratio for ACEIs vs. ARBs was 0.86 (95% confidence interval [CI], 0.68-1.10) for 3-point MACE and 0.83 (95% CI 0.69-0.99) for 4-point MACE. The 1-year absolute risk differences were - 0.30% (95% CI - 1.80-1.21%) for 3-point MACE and - 1.16% (95% CI - 2.97-0.66%) for 4-point MACE. Results were consistent across subgroup analyses (stratified by age, sex, as well as baseline major atherosclerotic cardiovascular disease, heart failure, other antihypertensive therapy, insulin therapy, and calendar year) and sensitivity analyses.

conclusionsAmong older patients with T2DM, the initiation of ACEIs was associated with a trend toward lower risk of MACE compared to ARBs, implying the potential cardiovascular benefits of ACEIs in this population.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCardiovascular DiseasesDiabetes Mellitus, Type 2AgedAged, 80 and overAge FactorsChinaComparative Effectiveness ResearchDatabases, FactualFemaleHeart Disease Risk FactorsHumansMaleRisk AssessmentRisk FactorsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAngiotensin-converting enzyme inhibitorsAngiotensin II receptor blockersMajor cardiovascular events.OlderType 2 diabetes mellitus

Identifiers

PMID40329312
PMCPMC12057007

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.