Abstract | BACKGROUND: 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.
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Authors | Scott D Solomon, Madeline M Rice, Kathleen A Jablonski, Powell Jose, Michael Domanski, Marc Sabatine, Bernard J Gersh, Jean Rouleau, Marc A Pfeffer, Eugene Braunwald, Prevention of Events with ACE inhibition (PEACE) Investigators |
Journal | Circulation
(Circulation)
Vol. 114
Issue 1
Pg. 26-31
(Jul 04 2006)
ISSN: 1524-4539 [Electronic] United States |
PMID | 16801465
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Indoles
- trandolapril
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Topics |
- Aged
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Cardiovascular Diseases
(etiology, prevention & control)
- Chronic Disease
- Coronary Artery Disease
(complications, drug therapy)
- Female
- Glomerular Filtration Rate
(drug effects)
- Humans
- Indoles
(therapeutic use)
- Male
- Middle Aged
- Renal Insufficiency
(complications, physiopathology, prevention & control)
- Survival Analysis
- Treatment Outcome
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