Table 3.
Medical Therapies to Reduce Risk of Heart Failure
| Clinical Trial | No. of Patients* |
Patient Inclusion Criteria | HF Incidence | Relative Risk Reduction, % |
|
|---|---|---|---|---|---|
| Randomized, placebo- controlled trials |
|||||
| ACEI | HOPE (ramipril, 2.5 or 10 mg) |
9297 | Vascular disease (CAD, PVD, or stroke) or diabetes plus cardiac risk factor; creatinine <2.4 mg/dL |
Ramipril vs placebo, 9% vs 11% |
23 |
| ACEI | EUROPA (perindopril, 8 mg) |
12 218 | Documented stable CAD |
Perindopril vs placebo, 1.0% vs 1.7% |
39 |
| ACEI | SAVE (captopril, target 50 mg, TID) |
2231 | After acute MI; LVEF ≤40%; without HF symptoms |
Captopril vs placebo, 11% vs 16% |
37 |
| Antiplatelet (ADP inhibitor) | CURE (clopidogrel 300- mg load, then 75 mg) |
12 562 | Acute coronary syndrome: non–ST- segment elevation ECG changes or elevated cardiac enzymes |
Clopidogrel vs placebo, 3.7% vs 4.4% |
18 |
| ARB | RENAAL (losartan, 50–100 mg) |
1513 | Type 2 diabetes mellitus, nephropathy |
Losartan vs placebo, 11.9% vs 16.7% |
32 |
| ARB | IDNT (irbesartan, 300 mg) |
1715 | Hypertension, type 2 diabetes, nephropathy |
Irbesartan vs placebo, N/A |
23 |
| Statin | 4S (simvastatin 20–40 mg) |
4444 | History of MI or angina, cholesterol 213–309 mg/dL, triglycerides <221 mg/dL |
Simvastatin vs placebo, 8.3% vs 10.3% |
19 |
| Randomized, active- controlled trials |
|||||
| β-Blocker or ACEI, with tight BP control | UKPDS (captopril or atenolol, goal BP <150/85 mm Hg) |
1148 | Type 2 diabetes mellitus, hypertension |
Captopril or atenolol (BP <150/85 mm Hg) vs other drugs (BP <180/105 mm Hg), 3.6% vs 8.1% |
56 |
| Retrospective studies |
|||||
| β-Blocker | SOLVD (subanalysis of prevention trial) |
2107 | Asymptomatic LV dysfunction, ejection fraction <35% |
Enalapril plus β- blocker vs enalapril plus no β-blocker, N/A |
36 |
| β-Blocker | SAVE (subanalysis) |
2231 | Ejection fraction <40%, no overt HF, post-MI patients |
β-Blocker vs no β- blocker, 16.5% vs 22.6% |
32 |
ACEI indicates ACE inhibitor; PVD, peripheral vascular disease; SAVE, Survival And Ventricular Enlargement Trial; TID, 3 times per day; LVEF, LV ejection fraction; ADP, adenosine diphosphate; ARB, angiotensin receptor blocker; ECG, electrocardiogram; RENAAL, Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; IDNT, Irbesartan in Diabetic Nephropathy; N/A, not applicable; and BP, blood pressure.
Including whites, blacks, and Hispanics.
From Schocken DD, Benjamin EJ, Fonarow GC, et al. Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 2008;117:2544-2565.