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1、AHA2004: A-HeFT,PEACE,andRIO-NAValentinFusterMDDirector,CardiovascularInstituteMountSinaiMedicalCenterNewYork,NYChristopherCannonMDAssociateProfessorofMedicineBrighamandWomen'sHospitalBoston,MAJamesFergusonMDAssociateDirector,CardiologyStLuke'sEpiscopalHospitalandTexasHeartInstituteHouston,TX
2、MichaelWeberMDProfessorofMedicineSUNYDownstateCollegeofMedicineBrooklyn,NYA-HeFTAfrican-AmericanHeartFailureTrialA-HeFTA-HeFT1000blackpatients,NYHAclass3or4Isosorbidedinitrate(ISDN)plushydralazine,orplacebo,plusstandardtherapyPrimaryendpoint:death,hospitalization,changeinqualityoflife(QoL)A-H
3、eFTStudyterminatedbecauseprimaryendpointreachedearlyISDN/hydralazinegroup:6.2%eventrate,comparedwith10.2%inplacebogroupISDN/hydralazinegroup:43%reductionintherateofdeath,53%infirsthospitalization,plus"significant"improvementinQoLA-HeFTresultsEndpointISDN-hydralazine(n=518)Placebo(n=532)pPrima
4、ryendpointcompositescore-0.1-0.50.01All-causemortality(%)6.210.20.02FirstHFhospitalization(%)16.424.40.001ChangeinQoLscoreat6months-5.5-2.70.02A-HeFT"IwasdelightedwiththeresultsofthisstudybecausewehavebeenhearingoflatethatwhenitcametoHF,AfricanAmericanswerenotseeingthesamekindsofbenefitsthatw
5、hitepatientswereseeingwiththeuseofACEinhibitors....Nowwehaveaverycleardirectioninwhichtogo."WeberA-HeFT"Ihadn'treallykeptthisonmyradarscreen,andI'mveryexcitedtoseeanothermajoradvanceevenontopofalltheotherstandardtherapies."CannonA-HeFT"Thistrialabsolutelyblewmeaway."Benefitsontopofoptimumther
6、apy:70%ofpatientsonACEinhibitors16%to17%onARBsHighusageofbetablockers40%onspironolactoneFergusonA-HeFTCanweextrapolatetoallpatientswithheartfailure?Whites?Asians?ACEinhibitorswerefirstprovenagainstISDN/hydralazineMustfindoutwhetherthereisadditivityorpatient-/population-specificneedsWeberA-HeF
7、TSevenoreightdrugswithprovenbenefit:"Doyouthinkwearegoingtocombinealloftheseinthefuturewithasinglepillforthisparticulargroupofpatients?Itseemstomethatit'sgoingtobeimpossibletotakeallofthesedrugsatthesametime."FusterA-HeFT"Itwouldhavetobeareal
