Stable coronary artery disease (CAD) is a condition characterized by a reversible supply/demand mismatch due to ischemia, myocardial infarction (MI), or other cardiovascular diseases (CVD). Renin-angiotensin-system (RAS) inhibitors are drugs that are routinely used in the treatment of CVD and hypertension. This study aims to examine the efficacy of RAS inhibitors in patients with stable CAD.

This systematic review and meta-analysis of 24 trials included a total of 198,275 patients. Trials of RAS inhibitors vs. placebo in patients with stable CAD without heart failure were included. The researchers evaluated the trials are reported the following primary outcomes: death, cardiovascular death, angina, stroke, heart failure, MI, revascularization, and incident diabetes.

The trials indicated that RAS inhibitors reduced the risk of all-cause mortality (Rate ratio 0.84), cardiovascular mortality (0.74), MI (0.82), stroke (0.79), heart failure, revascularization, and angina, as compared with placebo (1.05). However, no significant difference in mortality was found in the RAS inhibitor group that included active controls. Further analysis confirmed the dependence of all-cause and cardiovascular mortality on the control event rate.

The research concluded that RAS inhibitors reduced the risk of cardiovascular death in patients with stable CAD only when compared with placebo but not with active controls.