| BackgroundAccording to a report published in2010, about three hundred thousand people in America are threatened by sudden cardiac death (SCD), the main risk factors of SCD is also coronary heart disease. Besides, constructing heart disease, myocardial disease, acute myocardial ischemia, gene mutation, abnormality of coronary artery and ventricular arrhythmia can all cause SCD, this makes the research of SCD more complex.Although the rapid progress of medicine, the rate of SCD is increasing rather than decreasing. The reason is that in the general people, the rate of CAD and heart failure is increasing year by year. No matter what races and sexes, the rate of SCD increases with age. For example, the incidence of SCD in the50th is100/100000a year, while in the75th, it is800/100000. Although the incidence of SCD increases with age, in the young people, the percentage of sudden death in all death is larger. This is because in these people, the impact of social and economical factor is greater. No matter in which age stages, the incidence of SCD in female is lower than in male. Also, the incidence of SCD varies in different races, but the mechanism has not been well explained. CAD exists in80%patients who developed SCD. The high risk group of SCD includes:syncope happened while the onset of cardiac arrhythmia, ventricular tachycardia or ventricular fibrillation occurs early after myocardial infarction, cardiac function is in grade NYHA class III or class IV, as well as people who have history of myocardial infarction.In order to dissolve the problem faced by cardiovascular experts, many prevention strategies have been introduced to clinical use. It has been authenticated that β-receptor blocker can reduce the incidence of SCD. LVEF is also the forecast of SCD. In addition, patient age varies, different body mass index (BMI), whether patient has hyperlipidemia or not, these all can influence the incidence rate of SCD in patients with CAD. Then comes the problem, that is, whether the result of our study will be affected by the factors mentioned above or not. In recent years, in order to find out useful strategies that can reduce the incidence of SCD or avoid it, scientists have carried out a lot of clinical trials, the intervention strategies include medication therapy or implanted cardiac defibrillator.In theory, angiotensin converting enzyme inhibitor (ACEI) may reduce the incidence of SCD. Up to now, both clinical trials and epidemiological studies demonstrate that angiotensin converting enzyme inhibitor have anti-arrhythmic effects both in pharmacological and clinical aspects. While, these randomized controlled trials (RCTs) which study the effect of ACEI/ARB on the prevention of SCD still contradicts.PurposeExperimental and epidemiological studies suggest that renin-angiotensin system blockers have an antiarrhythmic effect. However, evidence from randomized controlled trials (RCTs) for prevention of sudden cardiac death (SCD) remains controversial. This study sought to evaluate the efficacy of renin-angiotensin system blocker for secondary prevention of SCD in patients with cardiovascular disease (CVD) in the era of guidelines-based therapy.MethodsWe conducted a PubMed/EMBASE/CENTRAL search for RCTs evaluating ACEI/ARB for secondary prevention with at least6weeks follow-up and with data on SCD. Primary outcome was SCD. Second outcomes were cardiovascular mortality and all-cause mortality.ResultsTwenty three randomized controlled trials were identified evaluating a total of52,929patients with CVD. ACEIs/ARBs reduce the adds ratio (OR) of SCD (OR,0.84;95%CI,0.77-0.91).ConclusionsIn the second prevention of SCD, renin-angiotensin system blockers appear to reduce SCD. When the LVEF>40%, the impact of ACEI/ARBs on the prevention of sudden cardiac death is not obvious. When the age is no larger than60years old, the effect also has no statistic significance. |
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