Angiotensin-converting Enzyme Inhibitors (ACE) And Angiotensin Receptor Blockers (ARB) Appear To Attenuate Stroke Risk Over Time In Patients With Left Ventricular Assist Devices

Background Left ventricular assist devices (LVADs) are used as a bridge to transplant or as a destination therapy for patients with end-stage heart failure. LVADs are associated with increased stroke risk, and many patients on LVAD are treated with ACE/ARBs and vasodilators to keep their mean arterial pressure (MAP) at goal to minimize the risk of stroke. We hypothesized that ACE/ARBs and vasodilators can reduce the 5-year risk of stroke in patients with LVAD. Methods We retrospectively analyzed the effect of ACE/ARBs and vasodilators on 5-year risk of developing stroke in patients (n = 250) who have received LVADs at the Ohio State University Wexner Medical Center (OSUWMC). This study was approved by IRB at OSUWMC. After LVAD placement, dates of stroke as well as duration of ACE/ARBs and vasodilators over next 5 years were recorded. In addition, MAP and INR at clinic visits were recorded every 3 months. Results We found that taking ACE/ARBs or vasodilators at any point during the 5-year window did not significantly change the risk of developing stroke. However, we found that duration of ACE/ARBs is positively associated with time-to-stroke after LVAD placement (correlation coefficient = 0.75; P value < 0.001). We further divided stroke patients into two etiologies: ischemic and hemorrhagic strokes. Interestingly, duration of ACE/ARBs was positively correlated with time-to-ischemic strokes only (correlation coefficient = 0.92; P value < 0.001), but not with time-to-hemorrhagic strokes (correlation coefficient = 0.36; P value = 0.39). In addition, duration of vasodilators was not strongly correlated with time-to-stroke (correlation coefficient = 0.4; P value = 0.5). There were no significant differences in MAP and INR in patients on ACE/ARBs, vasodilators, both, or none. Conclusions The mechanism via which ACE/ARBs can delay the occurrence of ischemic stroke is unclear and necessitates further investigation. Importantly, our study suggests that ACE/ARBs may be preferred over vasodilators when managing hypertension in patients with LVADs as ACE/ARBs, especially when taken over an extensive period, may be protective against ischemic strokes. Left ventricular assist devices (LVADs) are used as a bridge to transplant or as a destination therapy for patients with end-stage heart failure. LVADs are associated with increased stroke risk, and many patients on LVAD are treated with ACE/ARBs and vasodilators to keep their mean arterial pressure (MAP) at goal to minimize the risk of stroke. We hypothesized that ACE/ARBs and vasodilators can reduce the 5-year risk of stroke in patients with LVAD. We retrospectively analyzed the effect of ACE/ARBs and vasodilators on 5-year risk of developing stroke in patients (n = 250) who have received LVADs at the Ohio State University Wexner Medical Center (OSUWMC). This study was approved by IRB at OSUWMC. After LVAD placement, dates of stroke as well as duration of ACE/ARBs and vasodilators over next 5 years were recorded. In addition, MAP and INR at clinic visits were recorded every 3 months. We found that taking ACE/ARBs or vasodilators at any point during the 5-year window did not significantly change the risk of developing stroke. However, we found that duration of ACE/ARBs is positively associated with time-to-stroke after LVAD placement (correlation coefficient = 0.75; P value < 0.001). We further divided stroke patients into two etiologies: ischemic and hemorrhagic strokes. Interestingly, duration of ACE/ARBs was positively correlated with time-to-ischemic strokes only (correlation coefficient = 0.92; P value < 0.001), but not with time-to-hemorrhagic strokes (correlation coefficient = 0.36; P value = 0.39). In addition, duration of vasodilators was not strongly correlated with time-to-stroke (correlation coefficient = 0.4; P value = 0.5). There were no significant differences in MAP and INR in patients on ACE/ARBs, vasodilators, both, or none. The mechanism via which ACE/ARBs can delay the occurrence of ischemic stroke is unclear and necessitates further investigation. Importantly, our study suggests that ACE/ARBs may be preferred over vasodilators when managing hypertension in patients with LVADs as ACE/ARBs, especially when taken over an extensive period, may be protective against ischemic strokes.