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Racial Differences in Response to Heart Failure Therapy?
Data from previous studies suggest that black patients with heart failure have poorer outcomes than do white patients. However, it is unclear whether there are racial differences in responses to drug therapy for heart failure.
Exner and colleagues examined data from 2 previously published trials that demonstrated the overall beneficial effects of the angiotensin-converting-enzyme (ACE) inhibitor enalapril for patients with left ventricular (LV) dysfunction. The 800 black enrollees in these trials were compared with 1196 white patients matched for LV ejection fraction, sex, age, and assignment to enalapril or placebo. During an average follow-up of nearly 3 years, black patients had significantly higher rates than did white patients for all-cause mortality (12.2 vs. 9.7 deaths per 100 person-years) and hospitalization for heart failure (13.2 vs. 7.7 episodes per 100 person-years). Compared with placebo, enalapril reduced the risk for hospitalization among white patients (by 44 percent) but not among black patients. Enalapril also lowered mean blood pressure significantly among white patients but not among black patients.
Comment: The benefits of enalapril appeared to be limited to white patients in these studies. An editorialist explains that genetic variability in drug-metabolizing enzymes and drug receptors is distributed differently among racial and ethnic groups; thus, it is not surprising that some drug therapies will be less effective in certain groups than in others. For now, clinicians probably should wait for expert consensus on how to translate these findings into clinical practice. Notably, another study (by Yancy and colleagues) suggests that black and white patients with heart failure respond similarly to carvedilol.
— AS Brett
Published in Journal Watch General Medicine May 11, 2001
Citation(s):
Exner DV et al. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med 2001 May 3 344 1351-1357.
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Wood AJJ. Racial differences in the response to drugs -- Pointers to genetic differences. N Engl J Med 2001 May 3 344 1393-1396.
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Yancy CW et al. Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med 2001 May 3 344 1358-1365.
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