Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
Open accessAbstract
BACKGROUND: Patients with congestive heart failure have a high mortality rate and are also hospitalized frequently. We studied the effect of an angiotensin-converting-enzyme inhibitor, enalapril, on mortality and hospitalization in patients with chronic heart failure and ejection fractions less than or equal to 0.35. METHODS: Patients receiving conventional treatment for heart failure were randomly assigned to receive either placebo (n = 1284) or enalapril (n = 1285) at doses of 2.5 to 20 mg per day in a double-bind trial. Approximately 90 percent of the patients were in New York Heart Association functional classes II and III. The follow-up averaged 41.4 months. RESULTS: There were 510 deaths in the placebo group (39.7 percent), as compared with 452 in the enalapril group (35.2 percent) (reduction in risk, 16 percent; 95 percent confidence interval, 5 to 26 percent; P = 0.0036). Although reductions in mortality were observed in several categories of cardiac deaths, the largest reduction occurred among the deaths attributed to progressive heart failure (251 in the placebo group vs. 209 in the enalapril group; reduction in risk, 22 percent; 95 percent confidence interval, 6 to 35 percent). There was little apparent effect of treatment on deaths classified as due to arrhythmia without pump failure. Fewer patients died or were hospitalized for worsening heart failure (736 in the placebo group and 613 in the enalapril group; risk reduction, 26 percent; 95 percent confidence interval, 18 to 34 percent; P less than 0.0001). CONCLUSIONS: The addition of enalapril to conventional therapy significantly reduced mortality and hospitalizations for heart failure in patients with chronic congestive heart failure and reduced ejection fractions.
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The coexistence of type 2 diabetes mellitus and heart failure, either with reduced or preserved ejection fraction, is frequent, affecting 30-40% of patients.
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients)”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [36]
In clinical trials of chronic HF patients, the prevalence of T2DM was around 30%, irrespective of HF phenotype.
“In clinical trials of chronic HF patients, the prevalence of T2DM was around 30%, irrespective of HF phenotype (i.e.HFrEF and HFpEF) (Table 3).31 -48”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [36]
The highest prevalence of T2DM was seen in trials of acute HF, around 40%.
“The highest prevalence of T2DM was seen in trials of acute HF (around 40%).”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [36]
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- Authors
- The SOLVD Investigators*
- Corresponding author
- The SOLVD Investigators*
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1991-08
- Volume
- 325
- Issue
- 5
- Pages
- 293-302
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2585382523
- Cited by
- 8,029
- References
- 15
- Citations by year
- 2026: 78 · 2025: 89 · 2024: 117 · 2023: 152 · 2022: 174 · 2021: 167 · 2020: 182 · 2019: 174 · 2018: 174 · 2017: 187 · 2016: 211 · 2015: 208 · 2014: 165 · 2013: 168 · 2012: 231
- FWCI
- 170.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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
- enalapril, ACE inhibitors, congestive heart failure, reduced left ventricular ejection fraction, mortality, hospitalization, heart failure progression, cardiac arrhythmias, NYHA functional class
- MeSH terms
- Blood Pressure, Cause of Death, Chronic Disease, Double-Blind Method, Electrolytes, Enalapril, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Kidney, Male, Middle Aged, Patient Compliance, Stroke Volume, Survival Rate
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