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Type: Journal article
Title: Cardiovascular critical event pathways for the progression of heart failure; A report from the ATLAS study
Author: Cleland, J.
Thygesen, K.
Uretsky, B.
Armstrong, P.
Horowitz, J.
Massie, B.
Packer, M.
Poole-Wilson, P.
Ryden, L.
Citation: European Heart Journal, 2001; 22(17):1601-1612
Publisher: W B Saunders Co Ltd
Issue Date: 2001
ISSN: 0195-668X
Statement of
J.G.F. Cleland, K. Thygesen, B.F. Uretsky, P. Armstrong, J.D. Horowitz, B. Massie, M. Packer, P.A. Poole-Wilson, and L. Rydén on behalf of the ATLAS investigators
Abstract: <h4>Aims</h4>To determine the sequence of critical cardiovascular events in the progression of heart failure, and whether aetiology or high-dose vs low-dose lisinopril affected these pathways.<h4>Methods and results</h4>This was a post-hoc investigation of the ATLAS database, which comprised 3164 patients with chronic heart failure, randomized to low- (2.5-5.0 mg. day(-1)) or high-dose (32.5-35.0 mg. day(-1)) lisinopril, followed up for a median of 46 months. Two-thirds (64.3%) of patients had heart failure attributed to ischaemic heart disease. During the study, most patients (61.1%) had at least one cardiovascular hospitalization and 42.5% of all patients died: most deaths (88.2%) were cardiovascular. Nearly half (49.7%) of the cardiovascular deaths were considered sudden and 45.2% of cardiovascular deaths occurred as the first cardiovascular event. A third (30.2%) of deaths resulted from heart failure and were generally preceded by hospitalization, either for heart failure (85.5%), myocardial ischaemic events (21.7%) or arrhythmias (18.0%). Compared with low-dose, high-dose lisinopril was associated with a lower risk of death or hospitalization for any reason (P=0.002) and death or hospitalization with worsening heart failure (P<0.001). High-dose lisinopril delayed the time to all-cause mortality and hospitalization for chronic heart failure by 7.1 months.<h4>Conclusions</h4>Vascular and arrhythmic events may not only be important precipitants of sudden death, but were also seen to contribute to the progression of heart failure. A reduction in vascular events, as well as benefits on ventricular remodelling, could account for the decrease in death or hospitalization with high-dose lisinopril.
Keywords: heart failure
critical events pathways
Description: © 2001 by the European Society of Cardiology.
DOI: 10.1053/euhj.2000.2570
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