Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: Results from the Valsartan Heart Failure Trial (Val-HeFT)

Maggioni, Aldo P.; Latini, Roberto; Carson, Peter E.; Singh, Steven; Barlera, Simona; Glazer, Robert; Masson, Serge; Cerè, E; Tognoni, Gianni; Cohn, Jay N.

doi:10.1016/j.ahj.2004.09.033

Cited by 364 publications

(183 citation statements)

References 30 publications

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“…It seems reasonable to postulate that these negative effects may affect prognosis, particularly in the elderly, in whom the loss of atrial contribution greatly limits cardiac reserve [15] and predisposes to thromboembolism [19]. The incidence and prevalence of AF increases with age and worsening HF [12,20], and our data also confirm the elevated prevalence of AF in patients of advanced age and NYHA class. In all 3 groups of our study population, the presence of AF in patients with HF was strongly associated with previous hospitalizations, reinforcing the relationship between AF and a worse clinical profile of HF.…”

Section: Discussionsupporting

confidence: 76%

Age-Dependent Prognostic Significance of Atrial Fibrillation in Outpatients with Chronic Heart Failure: Data from the Italian Network on Congestive Heart Failure Registry

et al. 2010

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Objectives: The role of atrial fibrillation (AF) in older patients with heart failure (HF) is controversial because many variables seem to influence their outcome. We investigated the predictivity of AF in 3 age groups of outpatients with HF. Methods: We analyzed 8,178 outpatients enrolled in the Italian Network on Congestive Heart Failure Registry with HF diagnosed according to the European Society of Cardiology criteria. A trained cardiologist established the diagnosis of AF and HF at the entry visit at each center. We stratified the population into 3 age groups, as follows: group A, ≤65 years; group B, 66–75 years, and group C, >75 years. Results: Group A was composed of 4,261 patients, 683 with AF (16.0%); in group B there were 2,651 patients, 638 with AF (24.1%), and group C was composed of 1,266 patients, 412 with AF (32.5%). The 1-year mortality rate was higher in AF patients in all groups. In a multivariate model, AF remained an independent risk factor for death in groups A and B, but not in group C [group A: hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.10–1.81; group B: HR 1.29, 95% CI 1.00–1.67; group C: HR 1.05, 95% CI 0.78–1.43]. Conclusion: The prevalence of AF increased with age and was associated with a higher mortality rate. However, AF independently predicted all-cause mortality only in patients aged ≤75 years.

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Section: Discussionsupporting

confidence: 76%

Age-Dependent Prognostic Significance of Atrial Fibrillation in Outpatients with Chronic Heart Failure: Data from the Italian Network on Congestive Heart Failure Registry

et al. 2010

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“…A similar finding was observed in patients with and without CHF at baseline. In comparison, post‐hoc analyzes of randomized, controlled trials in patients with CHF but without known AF have suggested that RAS inhibition might reduce the incidence of new‐onset AF 33, 34, 35. In contrast, 2 prospective, randomized trials on patients with AF did not show beneficial effects of RAS inhibition with regard to future AF burden similar to our findings 36, 37.…”

Section: Discussionsupporting

confidence: 83%

Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but Do Not Prevent New‐Onset Atrial Fibrillation After Acute Myocardial Infarction

Batra

Lindhagen²,

Andell

et al. 2017

JAHA

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BackgroundTreatment with renin‐angiotensin system (RAS) inhibitors might restrain the structural/electrical remodeling associated with atrial fibrillation (AF). Limited evidence exists regarding the potential benefits of RAS inhibition post‐acute myocardial infarction (AMI) in patients with AF. This study sought to assess the association between RAS inhibition and all‐cause mortality and new‐onset AF in patients with/without congestive heart failure (CHF) post‐AMI.Methods and ResultsPatients hospitalized for AMI between 2006 and 2012 were identified in Swedish registries. Patients were stratified in 4 subgroups; patients with CHF and AF (n=11 489); patients with CHF without AF (n=31 676); patients with AF without CHF (n=10 066); and patients without both CHF and AF (n=59 417). Patients exposed to RAS inhibition were compared to nontreated. Three‐year risk of all‐cause mortality and new‐onset AF was assessed using adjusted Cox regression analyses. At discharge, 83 291 (73.9%) patients received RAS inhibition. RAS inhibition was associated with lower 3‐year risk of all‐cause mortality in CHF patients with AF, adjusted hazard ratio (HR) with 95% CI 0.75 (0.70–0.81), CHF patients without AF, HR 0.65 (0.60–0.69), AF patients without CHF, HR 0.82 (0.75–0.90), and in patients without CHF and AF, HR 0.76 (0.72–0.81), respectively. RAS inhibition was not associated with lower 3‐year risk of new‐onset AF in patients without AF but with/without CHF; HR 0.96 (0.84–1.10) and 1.12 (1.02–1.22), respectively.Conclusions RAS inhibition post‐AMI was associated with lower risk of all‐cause mortality. In patients with/without CHF, RAS inhibition was not associated with lower incidence of new‐onset AF.

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“…Despite the apparent benefit of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing AF in patients with HF (102,104,157), the role of statins for AF prophylaxis in HF is far from being completely understood (103). The doubleblind, placebo-controlled trial GISSI-HF found that rosuvastatin marginally reduced the incidence of AF in 3690 patients with HF (13.9% on rosuvastatin vs. 16.0% on placebo), even though the difference only reached statistical significance after adjustment for clinical variables, laboratory examinations, and background therapies (p = 0.038) (103).…”

Section: Af In Hfmentioning

confidence: 99%

Targeting Inflammation and Oxidative Stress in Atrial Fibrillation: Role of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibition with Statins

Pinho-Gomes

Reilly

Brandes

et al. 2014

Antioxidants & Redox Signaling

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Significance: Atrial fibrillation (AF) is a burgeoning health-care problem, and the currently available therapeutic armamentarium is barely efficient. Experimental and clinical evidence implicates inflammation and myocardial oxidative stress in the pathogenesis of AF. Recent Advances: Local and systemic inflammation has been found to both precede and follow the new onset of AF, and NOX2-dependent generation of reactive oxygen species in human right atrial samples has been independently associated with the occurrence of AF in the postoperative period in patients undergoing cardiac surgery. Anti-inflammatory and antioxidant agents can prevent atrial electrical remodeling in animal models of atrial tachypacing and the new onset of AF after cardiac surgery, suggesting a causal relationship between inflammation/oxidative stress and the atrial substrate that supports AF. Critical Issues: Statin therapy, by redressing the myocardial nitroso-redox balance and reducing inflammation, has emerged as a potentially effective strategy for the prevention of AF. Evidence indicates that statins prevent AF-induced electrical remodeling in animal models of atrial tachypacing and may reduce the new onset of AF after cardiac surgery. However, whether statins have antiarrhythmic properties in humans has yet to be conclusively demonstrated, as data from randomized controlled trials specifically addressing the relevance of statin therapy for the primary and secondary prevention of AF remain scanty. Future Directions: A better understanding of the mechanisms underpinning the putative antiarrhythmic effects of statins may afford tailoring AF treatment to specific clinical settings and patient's subgroups. Large-scale randomized clinical trials are needed to support the indication of statin therapy solely on the basis of AF prevention. Antioxid. Redox Signal. 20, 1268Signal. 20, -1285

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Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: Results from the Valsartan Heart Failure Trial (Val-HeFT)

Cited by 364 publications

References 30 publications

Age-Dependent Prognostic Significance of Atrial Fibrillation in Outpatients with Chronic Heart Failure: Data from the Italian Network on Congestive Heart Failure Registry

Age-Dependent Prognostic Significance of Atrial Fibrillation in Outpatients with Chronic Heart Failure: Data from the Italian Network on Congestive Heart Failure Registry

Angiotensin‐Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Are Associated With Improved Outcome but Do Not Prevent New‐Onset Atrial Fibrillation After Acute Myocardial Infarction

Targeting Inflammation and Oxidative Stress in Atrial Fibrillation: Role of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibition with Statins

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