Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure

Clyde W. Yancy, Michael B. Fowler, Wilson S. Colucci, Edward M. Gilbert, Michael R. Bristow, Jay N. Cohn, Mary Ann Lukas, Sarah T. Young, Milton Packer

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Abstract

Background The benefits of angiotensin-converting-enzyme inhibitors and beta-blockers may be smaller in black patients than in patients of other races, but it is unknown whether race influences the response to carvedilol in patients with chronic heart failure. Methods In the U.S. Carvedilol Heart Failure Trials Program, 217 black and 877 nonblack patients (in New York Heart Association class II, III, or IV and with a left ventricular ejection fraction of no more than 0.35) were randomly assigned to receive placebo or carvedilol (at doses of 6.25 to 50 mg twice daily) for up to 15 months. The effects of carvedilol on ejection fraction, clinical status, and major clinical events were retrospectively compared between black and nonblack patients. Results As compared with placebo, carvedilol lowered the risk of death from any cause or hospitalization for any reason by 48 percent in black patients and by 30 percent in nonblack patients. Carvedilol reduced the risk of worsening heart failure (heart failure leading to death, hospitalization, or a sustained increase in medication) by 54 percent in black patients and by 51 percent in nonblack patients. The ratios of the relative risks associated with ca for these two outcome variables in black as compared with nonblack patients were 0.74 (95 percent confidence interval, 0.42 to 1.34) and 0.94 (95 percent confidence interval, 0.43 to 2.05), respectively. Carvedilol also improved functional class, ejection fraction, and the patients' and physicians' global assessments in both the black patients and the nonblack patients. For all these measures of outcome and clinical status, carvedilol was superior to placebo within each racial cohort (P<0.05 in all analyses), and there was no significant interaction between race and treatment (P> 0.05 in all analyses). Conclusions The benefit of carvedilol was apparent and of similar magnitude in both black and nonblack patients with heart failure.

Original languageEnglish (US)
Pages (from-to)1358-1365
Number of pages8
JournalNew England Journal of Medicine
Volume344
Issue number18
DOIs
StatePublished - May 3 2001

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ASJC Scopus subject areas

  • Medicine(all)

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Yancy, C. W., Fowler, M. B., Colucci, W. S., Gilbert, E. M., Bristow, M. R., Cohn, J. N., Lukas, M. A., Young, S. T., & Packer, M. (2001). Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. New England Journal of Medicine, 344(18), 1358-1365. https://doi.org/10.1056/NEJM200105033441803