Effects of candesartan on mortality and morbidity in patients with chronic heart failure:: the CHARM-Overall programme
Effects of candesartan on mortality and morbidity in patients with chronic heart failure:: the CHARM-Overall programme
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DOI：
10.1016/s0140-6736(03)14282-1
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发表时间：
2003-09-06
期刊：
影响因子：
168.9
通讯作者：
Yusuf, S
中科院分区：
文献类型：
--
作者：
Pfeffer, MA;Swedberg, K;Yusuf, S
背景慢性心力衰竭(CHF)患者心血管死亡和再入院的风险很高。我们的目标是找出使用血管紧张素受体阻滞剂是否可以降低死亡率和发病率。方法在平行、随机、双盲、对照的临床试验中，我们在三个不同的人群中比较坎地沙坦和安慰剂。我们研究了左心室射血分数(LVEF)在40%或以下的患者，这些患者由于既往的不耐受性而没有接受血管紧张素转换酶抑制剂的治疗，或者目前正在接受血管紧张素转换酶抑制剂的治疗，以及LVEF高于40%的患者。总体而言，7601名患者(7599名有数据)被随机分为坎地沙坦(n=3803，每日滴定至32毫克)或匹配的安慰剂(n=3796)，并进行至少2年的随访。整个方案的主要结果是全因死亡率，而所有成分试验的主要结果是心血管死亡或因CHF入院。根据治疗意向进行分析。结果显示，平均随访时间为37.7个月。坎地沙坦组死亡886例(23%)，安慰剂组死亡945例(25%)(未调整风险比0.91[95%可信区间0.83-1.00]，p=0.055；协变量调整后0.90[0.82-0.99]，p=0.032)，心血管死亡较少(691[18%]vs769[20%]，未调整0.88[0.79-0.97]，p=0.012；协变量调整后为0.87[0.78-0.96]，p=0.006)和入院率(757[20%]vs918[24%]，p
Background Patients with chronic heart failure (CHF) are at high risk of cardiovascular death and recurrent hospital admissions. We aimed to find out whether the use of an angiotensin-receptor blocker could reduce mortality and morbidity.Methods In parallel, randomised, double-blind, controlled, clinical trials we compared candesartan with placebo in three distinct populations. We studied patients with left-ventricular ejection fraction (LVEF) 40% or less who were not receiving angiotensin-converting-enzyme inhibitors because of previous intolerance or who were currently receiving angiotensin-converting-enzyme inhibitors, and patients with LVEF higher than 40%. Overall, 7601 patients (7599 with data) were randomly assigned candesartan (n=3803, titrated to 32 mg once daily) or matching placebo (n=3796), and followed up for at least 2 years. The primary outcome of the overall programme was all-cause mortality, and for all the component trials was cardiovascular death or hospital admission for CHF. Analysis was by intention to treat.Findings Median follow-up was 37.7 months. 886 (23%) patients in the candesartan and 945 (25%) in the placebo group died (unadjusted hazard ratio 0.91 [95% CI 0.83-1.00], p=0.055; covariate adjusted 0.90 [0.82-0.99], p=0.032), with fewer cardiovascular deaths (691 [18%] vs 769 [20%], unadjusted 0.88 [0.79-0.97], p=0.012; covariate adjusted 0.87 [0.78-0.96], p=0.006) and hospital admissions for CHF (757 [20%] vs 918 [24%], p