1. Effect of candesartan on cause-specific mortality in heart failure patients: the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) program.
- Author
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Solomon SD, Wang D, Finn P, Skali H, Zornoff L, McMurray JJ, Swedberg K, Yusuf S, Granger CB, Michelson EL, Pocock S, and Pfeffer MA
- Subjects
- Aged, Biphenyl Compounds, Canada epidemiology, Cardiovascular Diseases prevention & control, Cause of Death, Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac prevention & control, Disease Progression, Female, Heart Failure mortality, Humans, Male, Middle Aged, Proportional Hazards Models, Single-Blind Method, Sweden epidemiology, United Kingdom epidemiology, United States epidemiology, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left prevention & control, Angiotensin II Type 1 Receptor Blockers therapeutic use, Benzimidazoles therapeutic use, Cardiovascular Diseases mortality, Heart Failure drug therapy, Tetrazoles therapeutic use
- Abstract
Background: Patients with heart failure are at increased risk of sudden death and death attributed to progressive pump failure. We assessed the effect of candesartan on cause-specific mortality in patients enrolled in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) program., Methods and Results: The CHARM program consisted of 3 component trials that enrolled patients with symptomatic heart failure: CHARM-Alternative (n=2028; LVEF<=40% [corrected] and ACE intolerant), CHARM-Added (n=2548; LVEF<=40%, [corrected] already on ACE inhibitors), and CHARM-Preserved (n=3023; LVEF >40%). Patients were randomized to candesartan, titrated to 32 mg QD, or placebo and were followed up for a median of 37.7 months. All deaths were reviewed by a blinded adjudication committee and categorized according to prespecified definitions on the basis of a narrative and source documentation. The number and rate of deaths by cause were calculated for each of the component trials and the overall program. Of all the patients, 8.5% died suddenly, and 6.2% died of progressive heart failure. Candesartan reduced both sudden death (HR 0.85 [0.73 to 0.99], P=0.036) and death from worsening heart failure (HR 0.78 [0.65 to 0.94], P=0.008). These reductions were most apparent in the patients with LVEF<=40% [corrected]., Conclusions: Candesartan reduced sudden death and death from worsening heart failure in patients with symptomatic heart failure, although this reduction was most apparent in patients with systolic dysfunction.
- Published
- 2004
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