Race in Heart Failure

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Heart failure Pub Date : 2025-01-01 DOI:10.1016/j.jchf.2024.08.008

Henri Lu MD , Brian L. Claggett PhD , Milton Packer MD , Maria A. Pabon MD , Marc A. Pfeffer MD, PhD , Eldrin F. Lewis MD, MPH , Carolyn S.P. Lam MBBS, PhD , Jean Rouleau MD , Michael R. Zile MD , Martin Lefkowitz MD , Akshay S. Desai MD, MPH , Pardeep S. Jhund MBChB, MS, PhD , John J.V. McMurray MD , Scott D. Solomon MD , Muthiah Vaduganathan MD, MPH

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Abstract

Background

Mechanisms of disease pathobiology, prognosis, and potentially treatment responses might vary by race in patients with heart failure (HF).

Objectives

The authors aimed to examine the safety and efficacy of sacubitril/valsartan among patients with HF by self-reported race.

Methods

PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) were global, randomized clinical trials testing sacubitril/valsartan against a renin-angiotensin system inhibitor (RASi) (enalapril or valsartan, respectively) in patients with HF and left ventricular ejection fraction ≤40% (PARADIGM-HF) or left ventricular ejection fraction ≥45% (PARAGON-HF). Patients with self-reported race were categorized as White, Asian, or Black. We assessed the composite of first HF hospitalization or cardiovascular death, its components, and angioedema across races.

Results

Among 12,097 participants, 9,451 (78.1%) were White, 2,116 (17.5%) were Asian, and 530 (4.4%) were Black. Over a median follow-up of 2.5 years, Black (adjusted HR: 1.68; 95% CI: 1.42-1.98) and Asian patients (adjusted HR: 1.32; 95% CI: 1.18-1.47) experienced higher risks of the primary outcome compared with White patients. Treatment effects of sacubitril/valsartan vs RASi on the primary endpoint were consistent among White (HR: 0.84; 95% CI: 0.77-0.91), Asian (HR: 0.92; 95% CI: 0.78-1.10), and Black patients (HR: 0.79; 95% CI: 0.58-1.07; P_interaction = 0.58). Rates of severe angioedema were higher with sacubitril/valsartan vs RASi (White: 0.2% vs 0.1%; Black: 1.5% vs 0.0%; Asian: 0.1% vs 0.1%).

Conclusions

In a pooled experience of 2 global trials, Black and Asian patients exhibited a higher risk of cardiovascular events than White patients. The benefits of sacubitril/valsartan were consistent across races. Risks of severe angioedema were low but numerically higher with sacubitril/valsartan. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255; Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)

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心力衰竭患者的种族：对全球 PARADIGM-HF 和 PARAGON-HF 试验参与者水平的汇总分析

心力衰竭（HF）患者的病理生物学机制、预后以及潜在的治疗反应可能因种族而异。作者的目的是根据自我报告的种族，研究心力衰竭患者服用沙库比妥/缬沙坦的安全性和疗效。他们在全球范围内开展了PARADIGM-HF（评估LCZ696与依那普利相比对慢性心力衰竭和射血分数降低患者发病率和死亡率的疗效和安全性的研究）和PARAGON-HF（评估LCZ696与缬沙坦相比对射血分数保留的心力衰竭患者发病率和死亡率的疗效和安全性的研究）、这些随机临床试验针对左室射血分数≤40%（PARADIGM-HF）或左室射血分数≥45%（PARAGON-HF）的心力衰竭患者，测试了沙库比特利/缬沙坦与肾素-血管紧张素系统抑制剂（[RASi]，分别为依那普利或缬沙坦）的对比效果。自报种族的患者被分为白人、亚裔或黑人。我们评估了不同种族的首次心房颤动住院或心血管死亡的复合情况、其组成部分以及血管性水肿。在 12,097 名参与者中，9,451 人（78.1%）为白人，2,116 人（17.5%）为亚裔，530 人（4.4%）为黑人。在中位随访 2.5 年期间，与白人患者相比，黑人患者（调整后 HR：1.68；95% CI：1.42-1.98）和亚裔患者（调整后 HR：1.32；95% CI：1.18-1.47）的主要结局风险更高。在白人患者（HR：0.84；95% CI：0.77-0.91）、亚裔患者（HR：0.92；95% CI：0.78-1.10）和黑人患者（HR：0.79 [95% CI：0.58-1.07]；= 0.58）中，沙库比曲/缬沙坦与 RASi 对主要终点的治疗效果一致。使用沙库比曲/缬沙坦与RASi相比，严重血管性水肿的发生率更高（白人：0.2% vs 0.1%；黑人：1.5% vs 0.0%；亚洲人：0.1% vs 0.1%）。在两项全球试验的汇总经验中，黑人和亚裔患者发生心血管事件的风险高于白人患者。在不同种族中，沙库比妥/缬沙坦的益处是一致的。发生严重血管性水肿的风险较低，但服用沙库比特利/缬沙坦后发生血管性水肿的风险在数量上要高一些。(评估 LCZ696 与依那普利相比对慢性心力衰竭和射血分数降低患者发病率和死亡率的疗效和安全性的多中心、随机、双盲、平行组、主动对照研究 [PARADIGM-HF]；一项多中心、随机、双盲、平行组、主动对照研究，评估 LCZ696 与缬沙坦相比对射血分数保留型心力衰竭患者发病率和死亡率的疗效和安全性 [PARAGON-HF]; )

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.