The following is a summary of “Comparative Risk of Angioedema With Sacubitril-Valsartan vs Renin-Angiotensin-Aldosterone Inhibitors,” published in the January 2023 issue of Cardiology by Eworuke, et al.

There were few facts on angioedema risk in actual life situations for sacubitril-valsartan (SV) users. Therefore, as opposed to new users of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), researchers compared the risk of angioedema among SV users to those of these drugs individually.

They performed a propensity score-matched cohort research comparing SV new users (no use of SV, ACE inhibitor, or ARB 6 months before) to SV new users who had recently used an ACE inhibitor or an ARB (within 183 or 14 days, respectively) to compare ACE inhibitor-SV and ARB-SV users.

SV new users and ACE inhibitor-SV users both had a decreased risk of angioedema when compared to ACE inhibitors (HR: 0.18; 95% CI: 0.11-0.29 and HR: 0.31; 0.23-0.43, respectively). Contrarily, there was no change in angioedema risk when SV new users or ARB-SV users were compared to ARB new users (HR: 0.59; 95% CI: 0.35-1.01) or ARB-SV users (HR: 0.85; 95% CI: 0.58-1.26). Users of ACE inhibitors combined with SV had a trend toward greater angioedema risk compared to SV new users (HR: 1.62; 95% CI: 0.91-2.89), which increased when the transition from ACE inhibitor to SV had placed within 14 days (recent ACE inhibitor-SV; HR: 1.98; 95% CI: 1.11-3.53). Similar to SV new users, those who switched to ARB-SV recently (recent ARB-SV) reported a higher risk (HR: 2.45; 95% CI: 1.36-4.43) than those who did not (HR: 2.03; 1.16-3.54).

Comparing SV new users to ACE inhibitor or ARB users, they did not see a higher incidence of angioedema. However, compared to SV new users, SV users who had just moved from ACE inhibitor or ARB had a higher incidence of angioedema.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.033