Published online before print June 26, 2006, doi: 10.1161/CIRCULATIONAHA.105.592733
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;114:26-31.)
© 2006 American Heart Association, Inc.
Coronary Heart Disease |
Renal Function and Effectiveness of Angiotensin-Converting Enzyme Inhibitor Therapy in Patients With Chronic Stable Coronary Disease in the Prevention of Events with ACE inhibition (PEACE) Trial
From the Cardiovascular Division (S.D.S., P.J., E.B., M.A.P.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; the National Heart, Lung, and Blood Institute (M.D.), Bethesda, Md; the George Washington University Biostatistics Center (M.M.R., K.A.J.), Rockville, Md; the University of Montreal (J.L.R.), Montreal, Quebec, Canada; and the Mayo College of Medicine (B.J.G.), Rochester, Minn.
Correspondence to Scott D. Solomon, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail ssolomon{at}rics.bwh.harvard.edu
Received October 21, 2005; revision received March 28, 2006; accepted April 24, 2006.
Background— Patients with reduced renal function are at increased risk for adverse cardiovascular outcomes. In the post–myocardial infarction setting, angiotensin-converting enzyme (ACE) inhibitors have been shown to be as effective in patients with impaired renal function as in those with preserved renal function.
Methods and Results— We assessed the relation between renal function and outcomes, the influence of ACE inhibition on this relation, and whether renal function modifies the effectiveness of ACE inhibition in patients with stable coronary artery disease and preserved systolic function enrolled in the Prevention of Events with ACE inhibition trial (PEACE). Patients (n=8290) were randomly assigned to receive trandolapril (target, 4 mg/d) or placebo. Clinical creatinine measures were available for 8280 patients before randomization. The estimated glomerular filtration rate (eGFR) was calculated with the 4-point Modification of Diet in Renal Disease equation. Renal function was related to outcomes, and the influence of ACE-inhibitor therapy was assessed with formal interaction modeling. The mean eGFR in PEACE was 77.6±19.4, and 1355 (16.3%) patients had reduced renal function (eGFR <60 mg · mL–1 · 1.73 m–2). We observed a significant interaction between eGFR and treatment group with respect to cardiovascular and all-cause mortality (P=0.02). Trandolapril was associated with a reduction in total mortality in patients with reduced renal function (adjusted HR, 0.73; 95% CI, 0.54 to 1.00) but not in patients with preserved renal function (adjusted HR, 0.94; 95% CI, 0.78 to 1.13).
Conclusions— Although trandolapril did not improve survival in the overall PEACE cohort, in which mean eGFR was relatively high, trandolapril reduced mortality in patients with reduced eGFR. These data suggest that reduced renal function may define a subset of patients most likely to benefit from ACE-inhibitor therapy for cardiovascular protection.
CLINICAL PERSPECTIVE
Related Article:
-
Issue Highlights
Circulation 2006 114: 1.[Full Text]
This article has been cited by other articles:
 |
|
 |
|
  L. A. Weinrauch, J. Lin, and S. D. Solomon Mapping Directions for the Cardiorenal Conundrum: Where You End Up Depends Upon Where You Started, So Where Do We Go From Here? J. Am. Coll. Cardiol., April 1, 2008; 51(13): 1275 - 1276. [Full Text] [PDF]
|
|
|
|
 |
|
 E. F. Lewis, E. J. Velazquez, S. D. Solomon, A. S. Hellkamp, J. J.V. McMurray, J. Mathias, J.-L. Rouleau, A. P. Maggioni, K. Swedberg, L. Kober, et al. Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study Eur. Heart J., March 2, 2008; 29(6): 748 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Solomon, J. Lin, C. G. Solomon, K. A. Jablonski, M. M. Rice, M. Steffes, M. Domanski, J. Hsia, B. J. Gersh, J. M. O. Arnold, et al. Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease Circulation, December 4, 2007; 116(23): 2687 - 2693. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Brugts, E. Boersma, M. Chonchol, J. W. Deckers, M. Bertrand, W. J. Remme, R. Ferrari, K. Fox, M. L. Simoons, and on behalf of the EUROPA Investigators The Cardioprotective Effects of the Angiotensin-Converting Enzyme Inhibitor Perindopril in Patients With Stable Coronary Artery Disease Are Not Modified by Mild to Moderate Renal Insufficiency: Insights From the EUROPA Trial J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2148 - 2155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gupta, S. Verma, and G B J. Mancini ACE inhibitors: back to prime time? Heart, September 1, 2007; 93(9): 1015 - 1016. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Schiffrin, M. L. Lipman, and J. F.E. Mann Chronic Kidney Disease: Effects on the Cardiovascular System Circulation, July 3, 2007; 116(1): 85 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. G. Couser, S. Shah, and For the joint international Society of Nephrology/ A call to action on World Kidney Day, 8 March 2007 Nephrol. Dial. Transplant., March 1, 2007; 22(3): 676 - 677. [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Levey, S. P. Andreoli, T. DuBose, R. Provenzano, and A. J. Collins Chronic Kidney Disease: Common, Harmful, and Treatable--World Kidney Day 2007 Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 401 - 405. [Full Text] [PDF]
|
|
|
|
|
|
P. A. McCullough Chronic Kidney Disease: Tipping the Scale to the Benefit of Angiotensin-Converting Enzyme Inhibitors in Patients With Coronary Artery Disease Circulation, July 4, 2006; 114(1): 6 - 7. [Full Text] [PDF]
|
|