Abstract 2997: Long-Term Mortality Benefits of Enalapril in Patients With Left Ventricular Systolic Dysfunction: A 22-Year Follow-up of SOLVD
Background In the Studies of Left Ventricular Dysfunction (SOLVD), therapy with enalapril, an ACE inhibitor, for 3– 4 years reduced cardiovascular morbidity and mortality. We reported here the 22-year clinical outcomes of patients who were previously enrolled in SOLVD in Belgium.
Methods: In SOLVD, 558 Belgian patients with EF ≤35% were randomized to receive either enalapril or placebo. At trial closeout, all 433 survivors (218 on enalapril vs. 215 on placebo) were placed on enalapril and followed. Causes of death were ascertained based on clinical data while blinded to treatment assignment. Long-term survival and life expectancy were compared between those who received early enalapril therapy and those who received no or delayed therapy.
Results: No patients were lost to follow-up. The median duration of alive follow-up was 20.4 (range=18.4 –22.2) years from randomization or 17.1 (16.7–17.8) years since closeout. The overall 10-, 15-, and 20-year survival rates were 45%, 28%, and 17% respectively. All-cause mortality was lower in the enalapril group than in the placebo group (83% vs. 85%; Wilcoxon p=0.03 for Kaplan-Meier survival). The largest reduction was in deaths from worsening heart failure (25% vs. 35%; p=0.004). Early therapy with enalapril had an added mortality benefit over the post-trial period that was beyond what was derived in trial (78% vs. 81%; p=0.01). Patients who received early enalapril therapy had a 39% risk reduction in deaths from worsening heart failure as compared to those who received no or delayed therapy (HR=0.61; 95%CI=0.45, 0.83; p=0.002). The benefit of enalapril was observed in both the Prevention and Treatment arms of the trial. Life expectancy was increased by 28.3 (95%CI=7.5, 53.7; p=0.006) months in the enalapril group over the placebo group. Among patients who were alive at last contact, there was no difference in ACE inhibitor usage (overall=81%) between the groups (p=0.26).
Conclusions: In a 22-year follow-up of the Belgian SOLVD cohort, long-term survival and life expectancy were significantly increased in patients who received early therapy with enalapril as compared to those who received no or delayed therapy. The benefit of enalapril extended beyond the original trial period for nearly two additional decades.