种族与慢性心力衰竭患者对卡维地洛肾上腺素能阻滞剂的反应

Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure.

作者信息

Yancy C W, Fowler M B, Colucci W S, Gilbert E M, Bristow M R, Cohn J N, Lukas M A, Young S T, Packer M

机构信息

University of Texas Southwestern Medical Center, Dallas 75390-9047, USA.

出版信息

N Engl J Med. 2001 May 3;344(18):1358-65. doi: 10.1056/NEJM200105033441803.

DOI:10.1056/NEJM200105033441803

PMID:11333992

Abstract

BACKGROUND

The benefits of angiotensin-converting-enzyme inhibitors and beta-blockers may be smaller in black patients than in patients of other races, but it is unknown whether race influences the response to carvedilol in patients with chronic heart failure.

METHODS

In the U.S. Carvedilol Heart Failure Trials Program, 217 black and 877 nonblack patients (in New York Heart Association class II, III, or IV and with a left ventricular ejection fraction of no more than 0.35) were randomly assigned to receive placebo or carvedilol (at doses of 6.25 to 50 mg twice daily) for up to 15 months. The effects of carvedilol on ejection fraction, clinical status, and major clinical events were retrospectively compared between black and nonblack patients.

RESULTS

As compared with placebo, carvedilol lowered the risk of death from any cause or hospitalization for any reason by 48 percent in black patients and by 30 percent in nonblack patients. Carvedilol reduced the risk of worsening heart failure (heart failure leading to death, hospitalization, or a sustained increase in medication) by 54 percent in black patients and by 51 percent in nonblack patients. The ratios of the relative risks associated with carvedilol for these two outcome variables in black as compared with nonblack patients were 0.74 (95 percent confidence interval, 0.42 to 1.34) and 0.94 (95 percent confidence interval, 0.43 to 2.05), respectively. Carvedilol also improved functional class, ejection fraction, and the patients' and physicians' global assessments in both the black patients and the nonblack patients. For all these measures of outcome and clinical status, carvedilol was superior to placebo within each racial cohort (P<0.05 in all analyses), and there was no significant interaction between race and treatment (P> 0.05 in all analyses).

CONCLUSIONS

The benefit of carvedilol was apparent and of similar magnitude in both black and nonblack patients with heart failure.

摘要

背景

血管紧张素转换酶抑制剂和β受体阻滞剂对黑人患者的益处可能小于对其他种族患者，但种族是否会影响慢性心力衰竭患者对卡维地洛的反应尚不清楚。

方法

在美国卡维地洛心力衰竭试验项目中，217名黑人患者和877名非黑人患者（纽约心脏协会心功能分级为II、III或IV级，左心室射血分数不超过0.35）被随机分配接受安慰剂或卡维地洛（剂量为6.25至50毫克，每日两次），治疗长达15个月。回顾性比较了黑人患者和非黑人患者中卡维地洛对射血分数、临床状况和主要临床事件的影响。

结果

与安慰剂相比，卡维地洛使黑人患者任何原因导致的死亡或因任何原因住院的风险降低了48%，使非黑人患者降低了30%。卡维地洛使黑人患者心力衰竭恶化（导致死亡、住院或药物持续增加的心力衰竭）的风险降低了54%，使非黑人患者降低了51%。与非黑人患者相比，黑人患者中卡维地洛与这两个结局变量相关的相对风险之比分别为0.74（95%置信区间，0.42至1.34）和0.94（95%置信区间，0.43至2.05）。卡维地洛还改善了黑人患者和非黑人患者的心功能分级、射血分数以及患者和医生的整体评估。对于所有这些结局和临床状况指标，卡维地洛在每个种族队列中均优于安慰剂（所有分析中P<0.05），且种族与治疗之间无显著交互作用（所有分析中P>0.05）。