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Inhibitory effect of valsartan against progression of left ventricular dysfunction after myocardial infarction:
Hiroshi Suzuki1, Eiichi Geshi, Shuji Nanjyo
1Department of Medicine, Division of Cardiology, Showa University School of Medicine, Japan. hrsuzuki@med.showa-u.ac.jp
Insights
Valsartan and ACEI show similar efficacy in preventing left ventricular dysfunction post-myocardial infarction (MI) in Japanese patients. Valsartan demonstrated better tolerability with fewer adverse events compared to ACEI.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACEI) are known to reduce mortality post-myocardial infarction (MI).
- Angiotensin receptor blockers (ARB) effects post-MI are less established, particularly in Japanese populations.
- Left ventricular dysfunction is a significant complication following MI.
Purpose of the Study:
- To compare the efficacy of valsartan (an ARB) versus ACEI in preventing left ventricular dysfunction after acute MI in Japanese patients.
- To assess the safety and tolerability of valsartan compared to ACEI in this patient cohort.
Main Methods:
- A multicenter randomized study involving 241 acute MI patients.
- Patients were randomized to receive either valsartan (n=120) or ACEI (n=121).
- Left ventriculography was performed at baseline and 6 months; cardiovascular events and adverse events were monitored.
Main Results:
- Blood pressure and cardiovascular event rates were similar between the valsartan and ACEI groups.
- Valsartan showed a significantly lower incidence of adverse events (3.3%) compared to ACEI (12.4%).
- No significant differences were observed in left ventricular ejection fraction or end-diastolic volume index between the groups at 6 months.
Conclusions:
- Valsartan is as effective as ACEI in preventing left ventricular dysfunction in Japanese patients following acute MI.
- Valsartan is better tolerated than ACEI, with a lower rate of adverse events in this population.
Background:
Angiotensin-converting enzyme inhibitors (ACEI) reduce the mortality in the chronic phase of myocardial infarction (MI), and similar effects of angiotensin receptor blockers (ARB) have been reported. However, these effects of ARB have not yet been established in Japanese patients. A multicenter randomized study was designed for the present study to examine the effect of valsartan as compared to that of ACEI against left ventricular dysfunction after MI.
Methods And Results:
Patients with acute MI were randomly allocated to either the valsartan group (n=120; mean age 63 +/-1.0) or the ACEI group (n=121; mean age 62.9 +/-1.0) and followed up until 6 months. Left ventriculography was performed during hospital admission and at 6 months. The blood pressure was similar in the 2 groups throughout the study. The incidences of cardiovascular events and target vessel revascularization were similar, although that of adverse events was significantly higher in the ACEI (12.4%) than in the valsartan group (3.3%; P<0.05). There were no differences in left ventricular ejection fraction and left ventricular end-diastolic volume index between the groups.
Conclusions:
Valsartan exhibits similar efficacy effective to that of ACEI in preventing left ventricular dysfunction in Japanese patients with acute MI, and is, in addition, better tolerated than ACEI.
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