Hospitalizations for new heart failure among subjects with diabetes mellitus in the RENAAL and LIFE studies
Hospitalizations for new heart failure among subjects with diabetes mellitus in the RENAAL and LIFE studies
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DOI：
10.1016/j.amjcard.2005.07.061
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发表时间：
2005-12-01
影响因子：
2.8
通讯作者：
Shahinfar, S
中科院分区：
文献类型：
--
作者：
Carr, AA;Kowey, PR;Shahinfar, S
在血管紧张素11拮抗剂氯沙坦(RENAAL)治疗高血压终点降低(LIFE)和非胰岛素依赖型糖尿病(NIDDM)终点降低(RENAAL)的研究中，我们试图研究糖尿病患者心力衰竭(HF)的危险因素以及氯沙坦降压治疗与首次住院治疗之间的关系。我们评估了来自LIFE研究的1,195名高血压、左室肥厚和糖尿病患者，以及来自RENAAL研究的1,513名2型糖尿病和肾病患者。LIFE研究中的对照治疗是阿替洛尔，RENAAL研究中的是安慰剂。有心力衰竭病史的患者被排除在这项分析之外。在RENAAL研究中，与安慰剂相比，氯沙坦显著降低了因心衰首次住院的发生率(风险比0.74，p=0.037)；在LIFE研究中，与阿替洛尔相比，氯沙坦显著降低了首次住院的发生率(风险比为0.57，p=0.019)。参加RENAAL研究的患者患心力衰竭的风险更高(RENAAL与终生糖尿病患者的风险比3.0，p<；0.0001)。在RENAAL研究中，发生心衰的重要独立基线危险因素是尿白蛋白/肌酐比率、年龄、外周血管疾病、康奈尔产品、体重指数和既往心绞痛；在LIFE研究中，它们是康奈尔产品、既往心肌梗死、外周血管疾病、基线心房颤动、饮酒(反向关系)和尿白蛋白/肌酐比率。在肾脏和/或心血管风险较高的患者中，氯沙坦对降低新发心力衰竭住院风险的有益效果得到了证实。(C)2005 Elsevier Inc.保留所有权利。
We sought to study the risk factors for heart failure (HF) and the relation between antihypertensive treatment with losartan and the first hospitalization for HF in patients with diabetes mellitus in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) and Reduction of Endpoints in NIDDM with the Angiotensin 11 Antagonist Losartan (RENAAL) studies. We evaluated 1,195 patients with hypertension, left ventricular hypertrophy, and diabetes from the LIFE study and 1,513 patients with type 2 diabetes and nephropathy from the RENAAL study. The comparative treatments were atenolol in the LIFE study and placebo in the RENAAL study. Patients with a history of HF were excluded from this analysis. Losartan significantly reduced the incidence of first hospitalizations for HF versus placebo in the RENAAL study (hazard ratio 0.74, p = 0.037) and versus atenolol in the LIFE study (hazard ratio 0.57, p = 0.019). Patients enrolled in the RENAAL study were at a higher risk of developing HF (hazard ratio for RENAAL vs LIFE diabetics 3.0, p < 0.0001). The significant, independent baseline risk factors for the development of HF in the RENAAL study were urinary albumin/creatinine ratio, age, peripheral vascular disease, the Cornell product, body mass index, and previous angina; in the LIFE study they were the Cornell product, previous myocardial infarction, peripheral vascular disease, baseline atrial fibrillation, alcohol use (inverse relation), and urinary albumin/creatinine ratio. The beneficial effect of losartan on the reduction of risk for hospitalization for new HF was demonstrated in patients who were at high renal and/or high, cardiovascular risk. (c) 2005 Elsevier Inc. All rights reserved.