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Prevention of heart failure
1Cardiovascular Division, University of Minnesota Medical School, Minneapolis 55455, USA.
Insights
Preventing heart failure (HF) progression is key. Early treatment of asymptomatic left ventricular dysfunction (LVD) with beta-blockers may reverse remodelling, but their efficacy versus ACE inhibitors requires further study.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure (HF) is progressive, necessitating early intervention to prevent worsening.
- Asymptomatic left ventricular dysfunction (LVD) requires treatment to preserve quality of life and exercise capacity.
- Left ventricular remodelling and dilatation must be prevented to halt clinical progression.
Purpose of the Study:
- To evaluate the comparative efficacy of beta-blocking agents and ACE inhibitors in preventing HF progression.
- To determine the impact of beta-blockers on left ventricular remodelling and dimensions.
- To investigate the combined effect of carvedilol and enalapril versus monotherapy in mild HF.
Main Methods:
- The CARMEN trial is a double-blind, randomized, parallel-group study.
- It involves 450 patients diagnosed with mild heart failure.
- Patients will be treated with carvedilol, enalapril, or a combination of both.
Main Results:
- Previous trials show ACE inhibitors reduce HF development but not mortality.
- Beta-blockers have demonstrated improvements in left ventricular ejection fraction and dimensions in HF patients.
- The relative efficacy of beta-blockers versus ACE inhibitors in remodelling regression is currently unknown.
Conclusions:
- Inhibition of the sympathetic nervous system via beta-blockers is a logical approach for HF and LVD.
- The CARMEN study aims to elucidate the comparative benefits of carvedilol and enalapril in mild HF.
- Understanding these treatment effects is crucial for optimizing HF management and preventing adverse remodeling.
Abstract:
Heart failure (HF) is a progressive process and the objective of treatment should be to prevent progression. Treatment should begin at the stage of asymptomatic left ventricular dysfunction (LVD), not only to reduce mortality but also to preserve exercise capacity and quality of life. To prevent clinical progression in patients with asymptomatic LVD or HF, left ventricular remodelling and dilatation must be prevented. The SOLVD prevention trial-the only clinical trial on the prevention of HF-showed that ACE inhibition significantly reduced the development of HF, but did not significantly reduce mortality. Plasma norepinephrine is elevated in patients with asymptomatic LVD, is further elevated in patients with overt HF, and is correlated with increased mortality. Inhibition of the sympathetic nervous system by administration of beta-blocking agents is therefore a logical treatment for patients with HF or asymptomatic LVD. Clinical trials have shown that beta-blocking agents increase left ventricular ejection fraction and reduce left ventricular dimensions in patients with HF, indicating regression of left ventricular remodelling. Almost all the patients in these studies were receiving an ACE inhibitor as part of their background medication, therefore the relative efficacy of beta-blocking agents and ACE inhibitors in the regression of remodelling is not known. CARMEN, a double-blind, randomised, parallel group study of carvedilol versus enalapril versus carvedilol + enalapril in 450 patients with mild HF, will provide this information.