Valsartan effective alternative to ACE inhibitors after heart attack
Valsartan (Diovan), the angiotensin II receptor antagonist, is an effective alternative to angiotensin converting enzyme (ACE) inhibitors after heart attack, researchers report.
The valsartan in acute myocardial infarction trial (VALIANT) compared
valsartan with captopril in 14,703 patients who had developed heart failure
or left ventricular dysfunction after a myocardial infarction (MI). Patients
were randomised to receive captopril (titrated to a maximum dose of 50mg
three times a day), valsartan (titrated to 160mg twice a day) or a combination
of both drugs (titrated to captopril 50mg three times a day plus valsartan
80mg twice a day). Treatment was started 0.5 to 10 days after the MI.
After two years, the number of patients who had died was the same in
all three groups. “In patients with MI complicated by heart failure,
left ventricular dysfunction or both, valsartan is as effective as captopril
in reducing risk of death, reducing cardiovascular death, reducing non-fatal
MI and reducing heart failure,” said Dr Marc Pfeffer, trial author
and senior cardiovascular physician, Brigham and Women’s Hospital,
Boston, Massachusetts.
No additional survival benefits were seen in the combination group. Furthermore,
combination therapy resulted in an increased number of adverse events.
Overall number of adverse events was similar in the captopril and valsartan
groups, although different types of event were observed.
Dr Raymond Gibbons, chairman of the American Heart Association committee
on science sessions programme, said that the trial provided evidence
that valsartan could be used in patients who had unacceptable side effects
while taking ACE inhibitors. “It will impact on clinical practice
and, with time, on existing guidance,” he said.
Commenting on the VALIANT results, Dr Betram Pitt, Ann Arbor, Michigan,
said: “Clearly I would feel confident now to use an angiotensin
II receptor blocker as an equivalent to an ACE inhibitor in patients
after an acute MI with heart failure or left ventricular dysfunction.
Having said that, we need to be cautious about extrapolating the data.” He
stressed that the study only examined patients in an acute situation. “ACE
inhibitors remain the therapy of choice in chronic heart failure,” he
said.
The study was presented and discussed on 10 November at the American
Heart Association conference in Orlando, Florida. It is also published
in The New England Journal of Medicine (2003;349:1893). |
