Racial analysis of patients with myocardial infarction complicated by heart failure and/or left ventricular dysfunction treated with valsartan, captopril, or both.
OBJECTIVE
African Americans have a high incidence of heart failure (HF). Limited retrospective observational subgroup analyses of patients with left ventricular systolic dysfunction (LVSD) suggest marginal benefit of angiotensin-converting enzyme inhibitors in the prevention of HF hospitalizations or total mortality in African Americans.


BACKGROUND
Very few data exist concerning the effectiveness of angiotensin receptor blockers in this population.


METHODS
Baseline characteristics, treatments, and outcomes of patients from the U.S. (3,390 white and 340 African-American patients) in the VALIANT (VALsartan In Acute myocardial iNfarcTion) trial were compared. This trial included patients with an acute myocardial infarction (MI) after initial stabilization and documented LVSD and/or HF. Patients were randomly assigned to receive treatment with valsartan, captopril, or the combination; follow-up continued for up to 3 years (median 24.7 months).


RESULTS
African Americans had more coronary risk factors, more markers of poor outcome after MI, and were less likely to be revascularized when compared with white patients. After adjusting for treatment assignment, baseline characteristics, and post-infarction parameters, no difference was found in the 3-year rate of all-cause mortality, cardiovascular mortality, rehospitalization for HF, recurrent MI, or stroke between the 2 groups.


CONCLUSIONS
African Americans sustaining an acute MI with LVSD and/or HF had similar clinical outcomes compared with white Americans. Valsartan, captopril, or the combination had comparable effects on cardiovascular morbidity and mortality in African Americans and white Americans.
Prisant
L Michael
LM
Hypertension and Clinical Pharmacology, Medical College of Georgia, Augusta, Georgia 30912, USA. mprisant@mail.mcg.edu
Thomas
Kevin L
KL
Lewis
Eldrin F
EF
Huang
Zhen
Z
Francis
Gary S
GS
Weaver
W Douglas
WD
Pfeffer
Marc A
MA
McMurray
John J V
JJ
Califf
Robert M
RM
Velazquez
Eric J
EJ
D001741:Black or African American / Q000706:statistics & numerical data*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002216:Captopril / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013599:Systole; D013777:Tetrazoles / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D013777:Tetrazoles; D000068756:Valsartan; D002216:Captopril; D014633:Valine