Incidence and Predictors of Hyperkalemia in Patients With Heart Failure: An Analysis of the CHARM Program Akshay S. Desai, Karl Swedberg, John J. V. McMurray, Christopher B. Granger, Salim Yusuf, ...James B. Young, Mark E. Dunlap, Scott D. Solomon, James W. Hainer, Bertil Olofsson, Eric L. Michelson, Marc A. Pfeffer We examined the incidence and predictors of hyperkalemia in a broad population of patients with symptomatic heart failure enrolled in the CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) Program. Independent of assignment to candesartan or placebo, the risk of hyperkalemia increased with advanced age, male gender, baseline hyperkalemia, renal failure, diabetes, and background use of angiotensin-converting enzyme inhibitors or spironolactone. Candesartan increased the observed rate of hyperkalemia in these subgroups but was associated with a consistent reduction in the risk of cardiovascular death or heart failure hospitalization. Although renin-angiotensin-aldosterone antagonists improve clinical outcomes in heart failure patients, careful surveillance of serum potassium and creatinine is essential.
Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank G. Michael Felker, Larry A. Allen, Stuart J. Pocock, Linda K. Shaw, John ...J. V. McMurray, Marc A. Pfeffer, Karl Swedberg, Duolao Wang, Salim Yusuf, Eric L. Michelson, Christopher B. Granger, for the CHARM Investigators Among 36 routine laboratory measures in the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program, higher red cell distribution width showed the greatest association with cardiovascular death and heart failure hospitalization (adjusted hazard ratio 1.17 per 1 SD increase, p < 0.001). Only age and cardiomegaly showed better independent association with outcome. This finding was replicated in the Duke Databank, in which red cell distribution width continued to be strongly associated with mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001). Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.
Carvedilol Protects Better Against Vascular Events Than Metoprolol in Heart Failure: Results From COMET Willem J. Remme, Christian Torp-Pedersen, John G. F. Cleland, Philip A. Poole-Wilson, Marco ...Metra, Michel Komajda, Karl Swedberg, Andrea Di Lenarda, Phillip Spark, Armin Scherhag, Christine Moullet, Mary Ann Lukas Comprehensive adrenergic blockade by carvedilol and additional properties, including antioxidant effects, may lead to improved vascular function and vascular protection relative to beta-1 blockade alone. We compared vascular protective effects of carvedilol and metoprolol in the COMET (Carvedilol Or Metoprolol European Trial) study in 3,029 heart failure patients during 58 months of therapy. Carvedilol reduced myocardial infarctions (MI) by 21%, cardiovascular death or nonfatal MI by 19%, unstable angina by 29%, stroke or MI by 25%, fatal MI or fatal stroke by 54%, and death after nonfatal MI or stroke by 33% (all p < 0.05 vs. metoprolol). These results suggest a ubiquitous protective effect of carvedilol against major cardiovascular events.
Objectives Our aim was to examine continental and regional differences in baseline characteristics and post-discharge clinical outcomes in the EVEREST (Efficacy of Vasopressin Antagonism in Heart ...Failure: Outcome Study with Tolvaptan) trial. Background Continental and regional differences in clinical trials of acute heart failure syndromes (AHFS) have not been well studied. Methods We analyzed data from the EVEREST trial, which randomized 4,133 patients hospitalized for worsening (HF) and left ventricular ejection fraction ≤40% to oral tolvaptan, a vasopressin antagonist, or placebo and followed for a median of 9.9 months. Baseline characteristics, mortality, and outcomes were analyzed across North America (n = 1,251), South America (n = 688), Western Europe (564 patients), and Eastern Europe (n = 1,619). Results There were major differences between the 4 groups in the severity, etiology, and management of HF. Unadjusted 1-year mortality and cardiovascular mortality/HF hospitalization were 30.4% and 52.5% in North America, 27.2% and 41.6% in South America, 27.1% and 47.3% in Western Europe, and 20.5% and 35.3% in Eastern Europe. After adjustment, South American patients had the highest overall mortality (hazard ratio: 1.42, 95% confidence interval: 1.15 to 1.76), while Eastern European patients had the lowest cardiovascular death and HF hospitalization rate (hazard ratio: 0.84, 95% confidence interval: 0.73 to 0.97), compared with patients in North America. Conclusions Major continental and regional differences in HF severity, etiology, and management exist among AHFS patients, resulting in varied post-discharge outcomes, despite pre-defined selection criteria. These differences should be taken into account when planning global trials in AHFS. (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan EVEREST; NCT00071331 )
Reply Olsson, Lars, MB; Pfeffer, Marc A., MD, PhD, FACC; Swedberg, Karl, MD, FACC
Journal of the American College of Cardiology,
2007, Letnik:
49, Številka:
3
Journal Article
PDF
