ArticlesEffect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction: a follow-up study
Introduction
the end of scheduled follow-up of the studies of left ventricular dysfunction (SOLVD), treatment with the angiotensin-converting enzyme (ACE) inhibitor enalapril improved survival in patients with heart failure and left ventricular dysfunction, whereas in patients who were asymptomatic and had left ventricular dysfunction, no clear reduction in mortality was seen.1, 2 However, the risks of heart failure and myocardial infarction were reduced in the enalapril group,1, 3 suggesting that the reductions in morbidity seen in the trial could translate into improvements in long-term survival after the trial. Therefore, the extended studies of left ventricular dysfunction (X-SOLVD) followed up patients for an additional 9 years to assess the effect of enalapril on their long-term survival and life expectancy. We present 12-year follow-up data of all 6797 patients who were previously enrolled in the SOLVD prevention and treatment trials.
Section snippets
Study background and organization
The design, methods, and results of SOLVD have been reported elsewhere.1, 2, 4 In brief, 6797 individuals from Belgium, the USA, and Canada, with ejection fractions of 0·35 or less, were randomised to receive either enalapril or placebo for a median duration of 3·2 years. Patients who were not receiving treatment for heart failure at the time of randomisation were entered in the prevention trial, whereas those who were on treatment were entered in the treatment trial.
The present study was
Results
Follow-up data were available for 6784 of 6797 participants (99·8%). Five individuals in the enalapril group and eight in the placebo group were lost to follow-up (they could not be traced). In the prevention trial, median duration of follow-up was 11·2 years (IQR 10·3–12·1) from randomisation and 8·6 years (7·3–8·6) since the original study ended. In the treatment trial, median duration of follow-up was 12·1 years (11·4–13·0) from randomisation and 9·2 years (7·9–9·2) since the original study
Discussion
We showed that previous treatment with enalapril in patients with left ventricular systolic dysfunction during SOLVD resulted in a significant survival benefit that was seen beyond the original period of the two trials. In particular, our study extended the result of the SOLVD prevention trial (in which no clear reduction in mortality at the end of the trial was seen) by showing improved long-term survival after the original period of the study. From our data, we estimate that treatment of 1000
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