Valsartan in Acute Myocardial Infarction Trial (VALIANT): Rationale and design

Pfeffer, Marc A.; McMurray, John J.V.; Leizorovicz, Alain; Maggioni, Aldo P.; Rouleau, Jean‐Lucien; Werf, Frans Van de; Henis, Marc; Neuhart, Eric; Gallo, Paul; Edwards, Susan; Sellers, Mary Ann; Velázquez, Eric J.; Califf, Robert M.

doi:10.1067/mhj.2000.108832

Cited by 160 publications

(94 citation statements)

References 22 publications

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“…However, despite the importance of this topic, there are few studies focusing on this issue, and they have shown controversial results (30,33,41) This fact could be clinically relevant in the treatment of patients with MI and may also explain several discrepancies concerning its beneficial effects. Clinical trials, such as the Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan (8), Valsartan in Acute Myocardial Infarction Trial (28), and Losartan Heart Failure Survival Trial (29), have shown that AT 1 R blockers reduced the morbidity/mortality rate and are well tolerated in patients with MI (34). In patients with heart failure who do not have markedly altered cardiac contractility, AT 1 R blockers appears to have no clinical advantages over placebo treatment (23,44).…”

Section: Discussionmentioning

confidence: 99%

Effect of early versus late AT₁ receptor blockade with losartan on postmyocardial infarction ventricular remodeling in rabbits

Gónzalez¹,

Seropián²,

Krieger³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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González GE, Seropian IM, Krieger ML, Palleiro J, Lopez Verrilli MA, Gironacci MM, Cavallero S, Wilensky L, Tomasi VH, Gelpi RJ, Morales C. Effect of early versus late AT1 receptor blockade with losartan on postmyocardial infarction ventricular remodeling in rabbits. Am J Physiol Heart Circ Physiol 297: H375-H386, 2009. First published May 8, 2009 doi:10.1152/ajpheart.00498.2007.-To characterize the temporal activation of the renin-angiotensin system after myocardial infarction (MI) in rabbits, we examined cardiac ANG II type 1 receptor (AT1R) expression and ANG II levels from 3 h to 35 days. The effects of losartan (12.5 mg ⅐ kg Ϫ1 ⅐ day Ϫ1 ) on functional and histomorphometric parameters when treatment was initiated early (3 h) and late (day 15) post-MI and maintained for different periods of time [short term (4 days), midterm (20 days), and long term (35 days)] were also studied. AT1R expression increased in the MI zone at 15 and 35 days (P Ͻ 0.05). ANG II levels increased (P Ͻ 0.05) in the non-MI zone at 24 h and in the MI zone as well as in plasma at 4 days and then progressively decreased until 35 days. The survival rate was significantly lower in untreated MI and early long-term-treated animals. Diastolic pressure-volume curves in MI at 35 and 56 days shifted to the right (P Ͻ 0.05). This shift was even more pronounced in long-term-treated groups (P Ͻ 0.05). Contractility decreased (P Ͻ 0.05 vs. sham) in the untreated and long-term-treated groups and was attenuated in the midterm-treated group. The early administration of losartan reduced RAM 11-positive macrophages from 4.15 Ϯ 0.05 to 3.05 Ϯ 0.02 cells/high-power field (HPF; P Ͻ 0.05) and CD45 RO-positive lymphocytes from 2.23 Ϯ 0.05 to 1.48 Ϯ 0.01 cells/HPF (P Ͻ 0.05) in the MI zone at 4 days. Long-term treatment reduced the scar collagen (MI: 70.50 Ϯ 2.35% and MI ϩ losartan: 57.50 Ϯ 2.48, P Ͻ 0.05), determined the persistency of RAM 11-positive macrophages (3.02 Ϯ 0.13 cells/HPF) and CD45 RO-positive lymphocytes (2.77 Ϯ 0.58 cells/HPF, P Ͻ 0.05 vs. MI), and reduced the scar thinning ratio at 35 days (P Ͻ 0.05). Consequently, the temporal expressions of cardiac AT1R and ANG II post-MI in rabbits are different from those described in other species. Long-term treatment unfavorably modified post-MI remodeling, whereas midterm treatment attenuated this harmful effect. The delay in wound healing (early reduction and late persistency of inflammatory infiltrate) and adverse remodeling observed in long-term-treated animals might explain the unfavorable effect observed in rabbits.angiotensin II type 1 receptor blockers MYOCARDIAL INFARCTION (MI) leads to global structural alterations that involve infarcted as well as noninfarcted areas in a process collectively known as ventricular remodeling (26). The initial phase of remodeling, which starts in the acute phase of the MI, is associated with geometric changes and dilation of the MI zone, as a consequence of injured wall thinning (14, 26). Shortly afterward, this dilation may progress to the whole ventricle, and...

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Section: Discussionmentioning

confidence: 99%

Effect of early versus late AT₁ receptor blockade with losartan on postmyocardial infarction ventricular remodeling in rabbits

Gónzalez¹,

Seropián²,

Krieger³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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“…Patients were randomly assigned to receive valsartan (160 mg twice daily), captopril (50 mg 3 times a day), or both (80 mg of valsartan twice daily and 50 mg of captopril 3 times a day). 15,16 All of the patients gave written informed consent, and the research protocol was approved by the appropriate institutional review boards.…”

Section: Patientsmentioning

confidence: 99%

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

et al. 2008

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Abstract-The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: Ͼ140 mm Hg) or low blood pressure (systolic: Ͻ100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.

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“…Увеличение частоты применения статинов в по-следние 15 лет было показано в ряде российских и международных исследований. Так, по данным ис-следования VALIANT, в 2001 г. лишь 0,6 % россиян, перенесших острый ИМ, получали терапию статина-ми [30], в 2002 г. в исследовании АТР частота приема статинов составляла 11 % [15], в 2006-2008 гг., по дан-ным исследований MSS и ОСКАР, в г. Москве стати-ны получали в среднем 30 % всех нуждавшихся в них [12,14], в 2007 г. в исследовании РЕЛИФ уже 33,9 % [9-11], а в международном регистре CLARIFY, за-вершившемся в 2015 г. [29], частота приема статинов в целом по стране составила 88 %.…”

Section: Discussionunclassified

Study of a Trend in the Frequency of Using Main Drug Classes Indicated for the Treatment of Patients With Chronic Coronary Heart Disease in 2004 to 2014: Data From the CHD Prognosis Registry

Толпыгина¹,

Марцевич²

2016

Klinicist

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Valsartan in Acute Myocardial Infarction Trial (VALIANT): Rationale and design

Cited by 160 publications

References 22 publications

Effect of early versus late AT₁ receptor blockade with losartan on postmyocardial infarction ventricular remodeling in rabbits

Effect of early versus late AT₁ receptor blockade with losartan on postmyocardial infarction ventricular remodeling in rabbits

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

Study of a Trend in the Frequency of Using Main Drug Classes Indicated for the Treatment of Patients With Chronic Coronary Heart Disease in 2004 to 2014: Data From the CHD Prognosis Registry

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