Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction:: the CHARM-Preserved Trial
Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction:: the CHARM-Preserved Trial
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DOI：
10.1016/s0140-6736(03)14285-7
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发表时间：
2003-09-06
期刊：
影响因子：
168.9
通讯作者：
Östergren, J
中科院分区：
文献类型：
--
作者：
Yusuf, S;Pfeffer, MA;Östergren, J
一半的慢性心力衰竭（CHF）患者的左心室射血分数（LVEF）得以保留，但很少有治疗方法在此类患者中进行专门评估。在先前对CHIF和低LVEF或血管疾病和保留LVEF的患者的研究中，抑制肾素-血管紧张素系统是有益的。我们调查的效果，除了血管紧张素受体阻滞剂，目前treatment.Methods之间，1999年3月，2000年7月，我们随机分配3023例坎地沙坦（n=1514，目标剂量32毫克，每日一次）或匹配安慰剂（n=1509）。患者患有纽约心脏协会心功能II-IV级CHF，LVEF高于40%。主要结局为心血管死亡或因CHF住院。结果中位随访时间为36.6个月。坎地沙坦组333例（22%）患者和安慰剂组366例（24%）患者出现主要结局（未校正风险比0.89 [95% CI 0.77-1.03]，p=0.118;协变量校正后0.86 [0.74-1.01，p=0.051）。两组之间的心血管死亡没有差异（170 vs 170），但坎地沙坦组因CHF住院一次（230 vs 279，p=0.017）或多次的患者少于安慰剂组。包括非致死性心肌梗死和非致死性卒中的复合结局显示与主要复合结局相似的结果（388 vs 429;未校正0.88 [0.77-1.01]，p=0.078;协变量校正后为0.86 [0.75-0.99]，解释坎地沙坦在预防患有心力衰竭和LVEF高于40%的患者因CHIF入院方面具有中等影响。
Background Half of patients with chronic heart failure (CHF) have preserved left-ventricular ejection fraction (LVEF), but few treatments have specifically been assessed in such patients. In previous studies of patients with CHIF and low LVEF or vascular disease and preserved LVEF, inhibition of the renin-angiotensin system is beneficial. We investigated the effect of addition of an angiotensin-receptor blocker to current treatments.Methods Between March, 1999, and July, 2000, we randomly assigned 3023 patients candesartan (n=1514, target dose 32 mg once daily) or matching placebo (n=1509). Patients had New York Heart Association functional class II-IV CHF and LVEF higher than 40%. The primary outcome was cardiovascular death or admission to hospital for CHF. Analysis was done by intention to treat.Findings Median follow-up was 36.6 months. 333 (22%) patients in the candesartan and 366 (24%) in the placebo group experienced the primary outcome (unadjusted hazard ratio 0.89 [95% CI 0.77-1.03], p=0.118; covariate adjusted 0.86 [0.74-1.01, p=0.051). Cardiovascular death did not differ between groups (170 vs 170), but fewer patients in the candesartan group than in the placebo group were admitted to hospital for CHF once (230 vs 279, p=0.017) or multiple times. Composite outcomes that included non-fatal myocardial infarction and non-fatal stroke showed similar results to the primary composite (388 vs 429; unadjusted 0.88 [0.77-1.01], p=0.078; covariate adjusted 0.86 [0.75-0.99], p=0.037).Interpretation Candesartan has a moderate impact in preventing admissions for CHIF among patients who have heart failure and LVEF higher than 40%.