Role of Ischemic Heart Disease in Major Adverse Renal and Cardiac Events Among Individuals With Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial)
Section snippets
Methods
The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) rationale and design have been previously described.10 In brief, TOPCAT was a multinational, double-blind, randomized, placebo-controlled trial that collectively enrolled 3,445 patients from 6 countries: United States, Canada, Russia, Republic of Georgia, Argentina, and Brazil. The primary objective of the trial was to evaluate the efficacy of spironolactone relative to placebo for the
Results
There were 3,445 participants in TOPCAT. A total of 2,023 (59%) had IHD at the time of enrollment. Before matching, ischemic patients were younger and had higher rates of diabetes, hypertension and dyslipidemia (Table 1). They were also predominantly male and had lower BMI than patients without IHD. After matching, there were 1,747 patients with IHD and 1,207 patients without IHD (Table 1). The average age of matched participants was 68.6 ± 9.6 years, with females (52%), and Caucasians (90%)
Discussion
In this post hoc analysis of TOPCAT data, we found that the prevalence of IHD in this trial of patients with HFpEF was 59%, and that the participants with IHD had a 20% higher risk of MARCE compared to those without. Factors including BMI, smoking, diabetes mellitus and dyslipidemia were also found to contribute to the risk of MARCE. To our knowledge, this is the first study to examine the relationship between myocardial ischemia and MARCE in HFpEF patients.
The observed IHD prevalence in HFpEF
Authors Contribution
Peter A. McCullough, MD, MPH: Conceptualization, Methodology, Design, Supervision, Interpretation, Critical revision, Final approval, Agreement to be accountable; Gelareh Rahimi, PhD: Data acquisition, Software, Formal analysis, Data Curation, Writing - Original Draft, Final approval, Agreement to be accountable; Kristen M. Tecson: Interpretation, Critical revision, Final approval, Agreement to be accountable; Osama Elsaid, MD: Interpretation, Critical revision, Final approval, Agreement to be
Disclosures
The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.
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This work was funded in part by the Baylor Health Care System Foundation.