Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status

Shekelle, Paul G; Rich, Michael W.; Morton, Sally C.; Atkinson, C S; Tu, Wenli; Maglione, Margaret; Rhodes, Shannon; Barrett, Michael J.; Fonarow, Gregg C.; Greenberg, Barry; Heidenreich, Paul A.; Knabel, Tom; Konstam, Marvin A.; Steimle, Anthony; Stevenson, Lynne Warner

doi:10.1016/s0735-1097(03)00262-6

Cited by 460 publications

(295 citation statements)

References 27 publications

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“…Our data do contrast with the BEST trial findings, as well as our previous retrospective study,15 which yielded a statistically significant race interaction for beta‐blocker–associated benefit (ie, increased beta‐blocker benefit in whites compared with blacks for the composite end point of all‐cause mortality plus hospitalization). Given the totality of data, the BEST findings seem most easily explained as an agent‐specific effect, given that several studies with the other beta‐blocking agents concur with our current observations 31, 32. The contrast with our previous data is most likely attributed to differences in the end point used.…”

Section: Discussionsupporting

confidence: 56%

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Peterson

She

et al. 2018

JAHA

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BackgroundIt remains unclear whether beta‐blockade is similarly effective in black patients with heart failure and reduced ejection fraction as in white patients, but self‐reported race is a complex social construct with both biological and environmental components. The objective of this study was to compare the reduction in mortality associated with beta‐blocker exposure in heart failure and reduced ejection fraction patients by both self‐reported race and by proportion African genetic ancestry.Methods and ResultsInsured patients with heart failure and reduced ejection fraction (n=1122) were included in a prospective registry at Henry Ford Health System. This included 575 self‐reported blacks (129 deaths, 22%) and 547 self‐reported whites (126 deaths, 23%) followed for a median 3.0 years. Beta‐blocker exposure (BBexp) was calculated from pharmacy claims, and the proportion of African genetic ancestry was determined from genome‐wide array data. Time‐dependent Cox proportional hazards regression was used to separately test the association of BBexp with all‐cause mortality by self‐reported race or by proportion of African genetic ancestry. Both sets of models were evaluated unadjusted and then adjusted for baseline risk factors and beta‐blocker propensity score. BBexp effect estimates were protective and of similar magnitude both by self‐reported race and by African genetic ancestry (adjusted hazard ratio=0.56 in blacks and adjusted hazard ratio=0.48 in whites). The tests for interactions with BBexp for both self‐reported race and for African genetic ancestry were not statistically significant in any model (P>0.1 for all).ConclusionsAmong black and white patients with heart failure and reduced ejection fraction, reduction in all‐cause mortality associated with BBexp was similar, regardless of self‐reported race or proportion African genetic ancestry.

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Section: Discussionsupporting

confidence: 56%

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Peterson

She

et al. 2018

JAHA

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“…These differences have been explained by the different etiology of heart failure according to gender and even by the results of a meta-analysis that seem to suggest fewer benefits with certain drug groups, 12 as well as more adverse effects (such as cough) in women who took ACE inhibitors. 13 Recently, specific clinics for management of patients with heart failure have been developed leading to a better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Influence of Gender on Long‐term Prognosis of Patients With Chronic Heart Failure Seen in Heart Failure Clinics

Ramírez-Marrero

Anguita‐Sánchez

Castillo

2010

Clinical Cardiology

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Background: Controversy exists concerning the influence of gender in the prognosis of patients with heart failure and no evidence is available from specific heart failure clinics. Hypothesis: Women with ambulatory heart failure are managed differently than men, although their prognosis might be better than men. Methods and Results:We analyzed the clinical characteristics, complementary test results, treatment, and prognosis in 4720 patients with chronic heart failure seen in 62 specialized clinics forming part of a multicenter registry during a mean follow-up of 40 months. The mean age was 65 ± 12 years and 71% were men. The men were younger than the women and more often had a history of hyperlipidemia and ischemic heart disease. The men had a more advanced heart failure New York Heart Association (NYHA) functional class (III-IV) than the women and a greater frequency of systolic ventricular dysfunction. The men more often received treatment with β-blockers, vasodilators, and antiplatelet aggregators as well as higher mean doses as compared with the women. The overall survival after the follow-up was similar for both genders, although the women had lower rates of survival free of admission for heart failure. Conclusions: Despite the mortality of women and men with heart failure being similar, the rate of readmission for heart failure is greater in women in specialized heart failure clinics. These results may be associated with the pharmacological treatment differences observed.

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“…There have been many landmark clinical trials and metaanalyses of the use of ACE inhibitors (19)(20)(21)(22)(23)(24)(25) and beta-blockers (26)(27)(28)(29) in heart failure, as well as other meta-analyses (30)(31)(32), such that ACE inhibitors and beta-blockers have become standard therapy and should be considered in all patients diagnosed with heart failure. The timing of introduction should be individualized to maximize tolerability and long-term persistence with therapy.…”

Section: General Recommendationsmentioning

confidence: 99%

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

Arnold¹,

Liu²,

Demers³

et al. 2006

Canadian Journal of Cardiology

363

256

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Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status

Abstract: Angiotensin-converting enzyme inhibitors and beta-blockers provide life-saving benefits in most of the subpopulations assessed. Women with asymptomatic LV systolic dysfunction may not achieve a mortality benefit when treated with ACE inhibitors.

Cited by 460 publications

References 27 publications

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Race and Beta‐Blocker Survival Benefit in Patients With Heart Failure: An Investigation of Self‐Reported Race and Proportion of African Genetic Ancestry

Influence of Gender on Long‐term Prognosis of Patients With Chronic Heart Failure Seen in Heart Failure Clinics

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

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