PMID- 16226935
OWN - NLM
STAT- MEDLINE
DCOM- 20051201
LR  - 20221207
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 96
IP  - 7B
DP  - 2005 Oct 10
TI  - The African American Heart Failure Trial: a clinical trial update.
PG  - 44-8
AB  - Progressive vascular and myocardial remodeling in heart failure is effectively 
      slowed by therapy with neurohormonal antagonists, including 
      angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, 
      aldosterone antagonists, and adrenergic-receptor blockers. These therapies, along 
      with the correction of hemodynamic abnormalities, have dramatically reduced 
      morbidity and mortality in patients with heart failure. Endothelial dysfunction, 
      increased oxidative stress, and decreased bioavailability of nitric oxide (NO) 
      also occur in heart failure. Data suggest that endothelial dysfunction and 
      reduced NO bioavailability may be more prevalent in populations who self-identify 
      as African Americans. Thus, differences observed in the African American 
      population with respect to prevalence of heart failure, etiology, outcomes, and 
      response to medication may in part be explained by differences in the relative 
      contributions of neurohormonal activation and diminished NO bioavailability to 
      the progression of heart failure. The African American Heart Failure Trial 
      (A-HeFT) was designed to assess the benefit of fixed-dose combination isosorbide 
      dinitrate-hydralazine (ISDN-HYD) in an African American population with advanced 
      heart failure. The A-HeFT enrolled 1,050 African American patients with New York 
      Heart Association (NYHA) class III-IV heart failure with dilated ventricles and 
      low ejection fractions. Patients were randomized to receive either a fixed-dose 
      combination of ISDN-HYD or placebo added to standard neurohormonal blockade. The 
      primary end point was a composite score in which mortality, hospitalization, and 
      quality of life were weighted. On July 19, 2004, the independent Data Safety 
      Monitoring Committee recommended early termination of the trial because of a 
      significant mortality benefit in the cohort receiving fixed-dose ISDN-HYD. The 
      A-HeFT confirms the benefit of fixed-dose ISDN-HYD, which may enhance NO 
      bioavailability in African American patients with NYHA class III-IV heart failure 
      and suggests that NO-enhancing therapy is an effective new treatment strategy for 
      heart failure. In addition, the A-HeFT affirms the critical importance of the 
      inclusion of population subgroups in clinical trials both as a way to probe for 
      pathophysiologic mechanisms of disease and to devise optimal treatment 
      strategies. The rich and unique A-HeFT database will provide new opportunities to 
      understand the pathophysiology and management of heart failure.
FAU - Taylor, Anne L
AU  - Taylor AL
AD  - Division of Cardiology, University of Minnesota Medical School, Minneapolis, 
      Minnesota 55455, USA. taylo135@umn.edu
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
DEP - 20050809
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Nitric Oxide Donors)
RN  - 0 (Vasodilator Agents)
RN  - IA7306519N (Isosorbide Dinitrate)
SB  - IM
MH  - Adult
MH  - *Black or African American
MH  - Aged
MH  - *Cause of Death
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heart Failure/diagnosis/*drug therapy/*ethnology/mortality
MH  - Humans
MH  - Isosorbide Dinitrate/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Nitric Oxide Donors/*therapeutic use
MH  - Prognosis
MH  - Randomized Controlled Trials as Topic
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Vasodilator Agents/therapeutic use
RF  - 26
EDAT- 2005/10/18 09:00
MHDA- 2005/12/13 09:00
CRDT- 2005/10/18 09:00
PHST- 2005/10/18 09:00 [pubmed]
PHST- 2005/12/13 09:00 [medline]
PHST- 2005/10/18 09:00 [entrez]
AID - S0002-9149(05)01215-4 [pii]
AID - 10.1016/j.amjcard.2005.07.033 [doi]
PST - ppublish
SO  - Am J Cardiol. 2005 Oct 10;96(7B):44-8. doi: 10.1016/j.amjcard.2005.07.033. Epub 
      2005 Aug 9.