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Enalapril prevents clinical proteinuria in diabetic patients with low ejection fraction
S E Capes1, H C Gerstein, A Negassa
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada. scapes@fhs.csu.mcmaster.ca
Insights
Clinical proteinuria predicts heart failure hospitalization and mortality in patients with left ventricular dysfunction. Enalapril, an ACE inhibitor, helps prevent proteinuria in diabetic individuals with this condition.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Clinical proteinuria is a known risk factor for end-stage renal disease and cardiovascular disease.
- The role of proteinuria in patients with left ventricular (LV) dysfunction, and the impact of ACE inhibitors, remain unclear.
Purpose of the Study:
- To investigate the prevalence and correlates of clinical proteinuria in patients with LV dysfunction.
- To assess the predictive value of proteinuria for adverse cardiovascular outcomes.
- To determine the efficacy of enalapril in preventing new-onset proteinuria.
Main Methods:
- Analysis of data from the Studies of Left Ventricular Dysfunction (SOLVD) trials.
- Assessment of baseline proteinuria, cardiovascular risk factors, and New York Heart Association (NYHA) class.
- Evaluation of enalapril's effect on proteinuria development.
Main Results:
- 3.2% of participants had baseline proteinuria, associated with higher blood pressure, diabetes prevalence, lower ejection fraction, and more severe heart failure.
- Proteinuria independently predicted increased hospitalization for congestive heart failure (CHF) and mortality.
- Enalapril significantly reduced proteinuria risk in diabetic patients but not in non-diabetic patients.
Conclusions:
- Clinical proteinuria is an independent predictor of CHF hospitalization and mortality in patients with LV dysfunction.
- Enalapril demonstrates a significant benefit in preventing clinical proteinuria among diabetic patients with LV dysfunction.
Objective:
Clinical proteinuria is a risk factor for both end-stage renal disease and cardiovascular disease. The prevalence of clinical proteinuria, its correlates and predictive value, and the effect of ACE inhibitors in preventing clinical proteinuria in diabetic and nondiabetic patients with left ventricular (LV) dysfunction are unknown.
Research Design And Methods:
The Studies of Left Ventricular Dysfunction (SOLVD) trials were analyzed to determine the baseline distribution of clinical proteinuria and related cardiovascular risk factors, the effect of baseline proteinuria on the risk of hospitalization for congestive heart failure (CHF) and mortality, and the effect of enalapril in preventing new clinical proteinuria.
Results:
A total of 5,487 out of 6,797 SOLVD participants (81%) were assessed for proteinuria at baseline. A total of 177 patients (3.2%) had baseline proteinuria. These patients had significantly higher systolic (137 vs. 125 mmHg, P < or = 0.001) and diastolic (83 vs. 77 mmHg, P < or = 0.001) blood pressure levels, a higher prevalence of diabetes (41 vs. 18%, P < or = 0.001), a lower ejection fraction (26.2 vs. 27.3%, P < or = 0.05), and greater degree of CHF (New York Heart Association [NYHA] class III/IV in 22 vs. 10%, P < or = 0.001) than patients without baseline proteinuria. Patients with baseline proteinuria also had higher rates of hospitalization for CHF (relative risk 1.81 [95% CI 1.37-2.41], P = 0.0001) and mortality (1.73 [1.34-2.24], P = 0.0001). Enalapril prevented clinical proteinuria in diabetic patients (0.38 [0.17-0.81], P = 0.0123) but not in nondiabetic patients (1.43 [0.77-2.63], P = 0.2622) without baseline proteinuria.
Conclusions:
Clinical proteinuria is an independent predictor of hospitalization for CHF and mortality in diabetic and nondiabetic patients with LV dysfunction. Enalapril significantly reduces the risk of clinical proteinuria in diabetic patients with LV dysfunction.