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https://hdl.handle.net/2440/9869
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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 1522-9645 |
Statement of Responsibility: | 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 lisinopril ischaemia arrhythymia progression critical events pathways |
Description: | © 2001 by the European Society of Cardiology. |
DOI: | 10.1053/euhj.2000.2570 |
Published version: | http://dx.doi.org/10.1053/euhj.2000.2570 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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