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Adverse effects of left ventricular hypertrophy in the reduction of endpoints in NIDDM with the angiotensin II
G Boner1, M E Cooper, K McCarroll
1Department of Internal Medicine, Sackler Faculty of Medicine, University of Tel Aviv, Ramat Aviv, Tel Aviv, Israel. gboner1@barak-online.net
Insights
Left ventricular hypertrophy (LVH) significantly increases cardiovascular and renal risks in type 2 diabetes patients. Losartan treatment effectively reduced these risks in patients with LVH, bringing them to levels comparable to those without LVH.
Area of Science:
- Cardiology
- Nephrology
- Diabetology
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular and renal events in patients with type 2 diabetes and nephropathy.
- The RENAAL trial investigated losartan's effects on renal disease progression and mortality in this population.
Purpose of the Study:
- To investigate the impact of baseline LVH and losartan treatment on renal and cardiovascular (CV) events.
- To assess the association between LVH and adverse outcomes in patients with type 2 diabetes and nephropathy.
Main Methods:
- LVH assessed via ECG criteria (Cornell product, Sokolow-Lyon voltage).
- Proportional hazards models used to determine risk of renal or CV events.
- Baseline covariates included age, sex, blood pressure, proteinuria, and renal function markers.
Main Results:
- 12% of patients had baseline LVH.
- Losartan significantly reduced ECG measures of LVH.
- LVH was associated with increased risk of composite renal endpoints (doubling of serum creatinine/end-stage renal disease) and CV events.
- Losartan treatment in patients with LVH reduced both CV and renal risk to levels similar to those without LVH.
Conclusions:
- LVH is a significant predictor of adverse renal and cardiovascular outcomes in type 2 diabetes with nephropathy.
- Losartan effectively mitigates these risks in patients with LVH, normalizing outcomes to those without LVH.
Aims/Hypothesis:
We explored the impact of baseline left ventricular hypertrophy (LVH) and losartan treatment on renal and cardiovascular (CV) events in 1,513 patients from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial, which studied the effects of losartan on the progression of renal disease and/or death in patients with type 2 diabetes and nephropathy.
Materials And Methods:
LVH was assessed using ECG criteria (Cornell product and/or Sokolow-Lyon voltage). The risk of renal or CV events was determined by a proportional hazards model fit with treatment allocation and presence of LVH. Covariates at baseline included age, sex, systolic BP, mean arterial pressure, pulse, proteinuria, serum creatinine, albumin and haemoglobin.
Results:
A total of 187 subjects (12%) had LVH at baseline. Treatment with losartan resulted in a significant decrease in the Cornell product (-6.2%) and Sokolow-Lyon voltage (-6.3%). LVH was shown to be significantly associated with the primary endpoint, which was a composite of doubling of serum creatinine (DSCR), endstage renal disease (ESRD) or death (hazard ratio [HR]=1.44, p=0.011), as well as with the composite renal endpoint of DSCR/ESRD (HR=1.42, p=0.031) and CV events (HR=1.68, p=0.001). Losartan treatment of patients with LVH decreased the CV as well as renal risk to a level similar to that of patients without LVH.
Conclusions/Interpretation:
In patients with type 2 diabetes and nephropathy, LVH is associated with significantly increased risk of CV events and the progression of kidney disease. Importantly, in patients with LVH, losartan reduced the CV as well as the renal risk to a level similar to that seen in subjects without LVH.
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