Solomon Scott D, Wang Duolao, Finn Peter, Skali Hicham, Zornoff Leonardo, McMurray John J V, Swedberg Karl, Yusuf Salim, Granger Christopher B, Michelson Eric L, Pocock Stuart, Pfeffer Marc A
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02445, USA.
Circulation. 2004 Oct 12;110(15):2180-3. doi: 10.1161/01.CIR.0000144474.65922.AA. Epub 2004 Oct 4.
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.
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].
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.
心力衰竭患者猝死及因进行性泵衰竭导致死亡的风险增加。我们评估了坎地沙坦对心力衰竭降低死亡率和发病率评估（CHARM）项目中患者特定病因死亡率的影响。
CHARM项目由3个组成试验构成，纳入有症状心力衰竭患者：CHARM替代组（n = 2028；左室射血分数[LVEF]≤40%[校正后]且不耐受ACE抑制剂）、CHARM加用组（n = 2548；LVEF≤40%[校正后]且已服用ACE抑制剂）和CHARM保留组（n = 3023；LVEF>40%）。患者被随机分为坎地沙坦组，滴定至32 mg每日一次，或安慰剂组，并随访中位时间37.7个月。所有死亡病例由一个盲法判定委员会进行审查，并根据预先指定的定义，基于叙述和原始文件进行分类。计算每个组成试验及整个项目中按病因划分的死亡数量和死亡率。在所有患者中，8.5%为猝死，6.2%死于进行性心力衰竭。坎地沙坦降低了猝死（风险比[HR]0.85[0.73至0.99]，P = 0.036）和因心力衰竭恶化导致的死亡（HR 0.78[0.65至0.94]，P = 0.008）。这些降低在LVEF≤40%[校正后]的患者中最为明显。
坎地沙坦降低了有症状心力衰竭患者的猝死和因心力衰竭恶化导致的死亡，尽管这种降低在收缩功能障碍患者中最为明显。
