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(Circulation. 1999;100:1311-1315.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Diuretics and Risk of Arrhythmic Death in Patients With Left Ventricular Dysfunction
From the Clinical Trials Scientific Research Group, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (H.A.C., D.L.D., M.J.D.); the Division of Cardiology, Georgetown University Medical Center, Washington, DC (H.A.C., D.L.D.); and the Department of Biostatistics, University of North Carolina, Chapel Hill (C.E.D., Y.L.S.).
Correspondence to Howard A. Cooper, MD, Clinical Trials Scientific Research Group, National Heart, Lung, and Blood Institute, Two Rockledge Centre, Room 8149, 6701 Rockledge Dr, MSC 7936, Bethesda, MD 20892. E-mail Cooperh{at}nih.gov
Background—Treatment with diuretics has been reported to increase the risk of arrhythmic death in patients with hypertension. The effect of diuretic therapy on arrhythmic death in patients with left ventricular dysfunction is unknown.
Methods and Results—We conducted a retrospective analysis of 6797 patients with an ejection fraction <0.36 enrolled in the Studies Of Left Ventricular Dysfunction (SOLVD) to assess the relation between diuretic use at baseline and the subsequent risk of arrhythmic death. Participants receiving a diuretic at baseline were more likely to have an arrhythmic death than those not receiving a diuretic (3.1 vs 1.7 arrhythmic deaths per 100 person-years, P=0.001). On univariate analysis, diuretic use was associated with an increased risk of arrhythmic death (relative risk [RR] 1.85, P=0.0001). After controlling for important covariates, diuretic use remained significantly associated with an increased risk of arrhythmic death (RR 1.37, P=0.009). Only non–potassium-sparing diuretic use was independently associated with arrhythmic death (RR 1.33, P=0.02). Use of a potassium-sparing diuretic, alone or in combination with a non–potassium-sparing diuretic, was not independently associated with an increased risk of arrhythmic death (RR 0.90, P=0.6).
Conclusions—In SOLVD, baseline use of a non–potassium-sparing diuretic was associated with an increased risk of arrhythmic death, whereas baseline use of a potassium-sparing diuretic was not. These data suggest that diuretic-induced electrolyte disturbances may result in fatal arrhythmias in patients with systolic left ventricular dysfunction.
Key Words: diuretics • heart failure • arrhythmia • potassium
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