Effect of Enalapril on Mortality and the Development of Heart Failure in Asymptomatic Patients with Reduced Left Ventricular Ejection Fractions
Abstract
Background It is not known whether the treatment of patients with asymptomatic left ventricular dysfunction reduces mortality and morbidity. We studied the effect of an angiotensin-converting--enzyme inhibitor, enalapril, on total mortality and mortality from cardiovascular causes, the development of heart failure, and hospitalization for heart failure among patients with ejection fractions of 0.35 or less who were not receiving drug treatment for heart failure. Methods Patients were randomly assigned to receive either placebo (n = 2117) or enalapril (n = 2111) at doses of 2.5 to 20 mg per day in a double-blind trial. Follow-up averaged 37.4 months. Results There were 334 deaths in the placebo group, as compared with 313 in the enalapril group (reduction in risk, 8 percent by the log-rank test; 95 percent confidence interval, -8 percent [an increase of 8 percent] to 21 percent; P = 0.30). The reduction in mortality from cardiovascular causes was larger but was not statistically significant (298 deaths in the placebo group vs. 265 in the enalapril group; risk reduction, 12 percent; 95 percent confidence interval, -3 to 26 percent; P = 0.12). When we combined patients in whom heart failure developed and those who died, the total number of deaths and cases of heart failure was lower in the enalapril group than in the placebo group (630 vs. 818; risk reduction, 29 percent; 95 percent confidence interval, 21 to 36 percent; P less than 0.001). In addition, fewer patients given enal…
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The Studies of Left Ventricular Dysfunction Prevention study did not include patients with impaired renal function.
“That study, however, did not include patients with impaired renal function.”
From Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy (2001) · cites this paper as [31]
The finding of a reduced rate of first hospitalization for heart failure in patients without clinical heart failure at baseline accords well with findings from the Studies of Left Ventricular Dysfunction Prevention study.
“This finding in patients without clinical heart failure at base line accords well with findings from the Studies of Left Ventricular Dysfunction Prevention study. 31”
From Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy (2001) · cites this paper as [31]
In the SOLVD study, treatment with enalapril reduced incident heart failure in people with asymptomatic left ventricular dysfunction by 20%.
“In the landmark Studies of Left Ventricular Dysfunction (SOLVD) study, in which 15% of people had diabetes, treatment with enalapril reduced incident heart failure in people with asymptomatic left ventricular dysfunction by 20% (278).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [278]
In the SOLVD study, treatment with enalapril reduced incident heart failure in people with asymptomatic left ventricular dysfunction by 20%.
“In the landmark Studies of Left Ventricular Dysfunction (SOLVD) study, in which 15% of people had diabetes, treatment with enalapril reduced incident heart failure in people with asymptomatic left ventricular dysfunction by 20% (275).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [275]
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- Authors
- The SOLVD Investigators*
- Corresponding author
- The SOLVD Investigators*
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1992-09-03
- Volume
- 327
- Issue
- 10
- Pages
- 685-691
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2469805673
- Cited by
- 3,725
- References
- 0
- Citations by year
- 2026: 31 · 2025: 34 · 2024: 41 · 2023: 48 · 2022: 62 · 2021: 77 · 2020: 67 · 2019: 81 · 2018: 70 · 2017: 81 · 2016: 93 · 2015: 98 · 2014: 75 · 2013: 83 · 2012: 97
- FWCI
- 130.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- 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, heart failure prevention, asymptomatic left ventricular dysfunction, reduced ejection fraction, mortality, cardiovascular mortality, heart failure hospitalization, heart failure with preserved ejection fraction
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Double-Blind Method, Electrolytes, Enalapril, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Kidney, Male, Middle Aged, Stroke Volume
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