ACE inhibitor benefits persist 12 years in CHF. (Follow-up of Patients in Solvd Trails).

BERLIN -- The true benefits of ACE inhibitors in patients with heart failure are likely to be significantly greater than have been reported in the landmark clinical trials, Dr. Salim Yusuf said at the 24th Congress of the European Society of Cardiology.

He and his colleague Dr. Philip Jong presented the results of the Extended Studies of Left Ventricular Dysfunction (XSOLVD), an unprecedented 12-year follow-up study of participants in the landmark SOLVD prevention and treatment trials.

The original SOLVD trials randomized nearly 7,000 Americans, Canadians, and Belgians with congestive heart failure (CHF) or asymptomatic left ventricular dysfunction to enalapril or placebo, then followed them for a mean of 3.3 years.

In XSOLVD, 99.8% of the original SOLVD participants were tracked down 12 years after the studies had formally ended to learn how the patients had subsequently fared.

At the conclusion of the SOLVD prevention trial, patients with asymptomatic left ventricular dysfunction who received enalapril had significantly lower rates of MI and hospitalization than those who received placebo. But the overall survival rates at that time were not significantly different: 86% in the enalapril arm and 84% in controls.

XSOLVD revealed a continued divergence in survival over the next dozen years. At 5 years, the absolute difference had grown from 2% to 4%-77% survival in the enalapril arm and 73% in controls. At 12 years the margin had grown still further: 47% survival in the enalapril group and 41% in controls, a highly significant difference, Dr. Jong noted.

At the end of the SOLVD treatment trial, patients with CHE in the enalapril arm had a significant survival advantage: 64%, vs. 60% among controls. This ...