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Cited by 492Heart Failure Treatment and ManagementHeart rate and cardiovascular healthCardiovascular Function and Risk Factors

Efficacy of angiotensin-converting enzyme inhibitors and beta-blockers in the management of left ventricular systolic dysfunction according to race, gender, and diabetic status

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Shekelle, Paul G., Rich, Michael W., Morton, Sally C., Atkinson, Col.Sid W., Tu, Wenli, Maglione, Margaret, Rhodes, Shannon, Barrett, Michael +7 more·2003·Journal of the American College of Cardiology
DOI 10.1016/s0735-1097(03)00262-6
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Abstract

Objectives This study sought to assess the effect of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers on all-cause mortality in patients with left ventricular (LV) systolic dysfunction according to gender, race, and the presence of diabetes.Background Major randomized clinical trials have established that ACE inhibitors and beta-blockers have life-saving benefits in patients with LV systolic dysfunction. Most patients enrolled in these trials were Caucasian men. Whether an equal effect is achieved in women, non-Caucasians, and patients with major comorbidities has not been established.Methods The authors performed a meta-analysis of published and individual patient data from the 12 largest randomized clinical trials of ACE inhibitors and beta-blockers to produce random effects estimates of mortality for subgroups.Results Data support beneficial reductions in all-cause mortality for the use of beta-blockers in men and women, the use of ACE inhibitors and some beta-blockers in black and white patients, and the use of ACE inhibitors and beta-blockers in patients with or without diabetes. Women with symptomatic LV systolic dysfunction probably benefit from ACE inhibitors, but women with asymptomatic LV systolic dysfunction may not have reduced mortality when treated with ACE inhibitors (pooled relative risk = 0.96; 95% confidence interval: 0.75 to 1.22). The pooled estimate of three beta-blocker studies supports a beneficial effect in black patients with heart failure, but one study assessing bucindolol reported a nonsignificant increase in mortality.Conclusions Angiotensin-converting enzyme inhibitors and beta-blockers provide life-saving benefits in most of the subpopulations assessed. Women with asymptomatic LV systolic dysfunction may not achieve a mortality benefit when treated with ACE inhibitors.

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Authors
Shekelle, P. G., Rich, M. W., Morton, S. C., Atkinson, C. S. W., Tu, W., Maglione, M., Rhodes, S., Barrett, M., Fonarow, G. C., Greenberg, B., Heidenreich, P. A., Knabel, T., Konstam, M. A., Steimle, A., & Warner Stevenson, L.
Affiliations
  • RAND Corporation (US)
  • Washington University in St. Louis (US)
  • Drexel University (US)
  • University of California, Los Angeles (US)
  • University of California San Diego (US)
  • VA Palo Alto Health Care System (US)
  • Tufts University (US)
  • Kaiser Permanente Northern California (US)
Corresponding author
Shekelle, Paul G.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2003-05
Volume
41
Issue
9
Pages
1529-1538
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/s0735-1097(03)00262-6
OpenAlex
W61639876
Cited by
492
References
37
Citations by year
2026: 6 · 2025: 3 · 2024: 15 · 2023: 10 · 2022: 16 · 2021: 16 · 2020: 30 · 2019: 16 · 2018: 18 · 2017: 15 · 2016: 20 · 2015: 22 · 2014: 32 · 2013: 29 · 2012: 28
FWCI
17.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Public Health Service (290-97-0000, 290-97-0001)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
ACE inhibitors, beta-blockers, left ventricular systolic dysfunction, heart failure, all-cause mortality, subgroup analysis, sex differences, racial differences, diabetes mellitus, bucindolol, asymptomatic left ventricular dysfunction, individual patient data
MeSH terms
Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Diabetes Mellitus, Female, Humans, Male, Sex Factors, Systole, Survival Rate, Randomized Controlled Trials as Topic, Ventricular Dysfunction, Left, Racial Groups, Diabetes Complications

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