Copyright © 2000 by the European Society of Cardiology.
Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial
a Karolinska Institutet, Stockholm, Sweden
b University of Alberta, Edmonton, Canada
c University of Hull, U.K.
d University of Adelaide, Adelaide, Australia
e University of California, San Francisco, U.S.A.
f Columbia University, New York, U.S.A.
g Imperial College School of Medicine, University of London, U.K.
revised June 20, 2000; accepted June 21, 2000
Abstract
Aims An analysis was designed to determine whether chronic heart failure patients at high cardiovascular risk benefited to the same extent from high-dose lisinopril as the whole ATLAS population.
Methods and Results A retrospective analysis was performed on high-risk heart failure patients in the Assessment of Treatment with Lisinopril And Survival (ATLAS) trial (total number of patients 3164) comparing highdose (32·5–35mg.day–1) vs low-dose (2·5–5mg.day–1) lisinopril for a median of 46 months. These high-risk patients included those with hypotension, hyponatraemia, compromised renal function, the elderly and patients with diabetes mellitus at baseline. In the whole study population, high-dose lisinopril led to a trend in risk reduction of all-cause mortality (primary end-point P=0·128) and a significant risk reduction in all-cause mortality plus hospitalization (principal secondary end-point P=0·002). Subgroup analyses were performed for these end-points. There were no consistent interactions between age, baseline sodium, creatinine or potassium values, and treatment effect. Diabetics showed a beneficial response to high-dose therapy that was at least as good as that in non-diabetics. The underlying higher morbidity/mortality rates in diabetics mean that high-dose lisinopril has potential for a larger absolute clinical impact in these patients.
Conclusion Long-term high-dose lisinopril was as effective and well-tolerated in high-risk patients, including those with diabetes mellitus, as for the ATLAS study population as a whole.
Key Words: Heart failure, ACE inhibitor, mortality, hospitalization, lisinopril, diabetes mellitus
f1 Correspondence: Lars Rydén MD, Professor of Cardiology, Department of Cardiology, Karolinska Sjukhuset, S-171 76 Stockholm, Sweden.
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