Decreased diabetic cardiac death from losartan?

The angeotensin 2 receptor blocker losartan could be more effective than a beta blocker in reducing sudden cardiac death among diabetic patients with high blood pressure and an enlarged left ventricle (left ventricular hypertrophy), suggest authors of a research letter in this week's issue of THE LANCET.

The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study published by THE LANCET in March 2002 demonstrated a major reduction of all-cause mortality-especially cardiovascular mortality-in patients with diabetes with left ventricular hypertrophy treated with losartan. The LIFE diabetes study investigators (led by Lars Hjalmar Lindholm from Umea University, Sweden, and colleagues) proposed that losartan might offer better protection against sudden cardiac death than atenolol.

In a post-hoc analysis of 1195 participants in the LIFE study, 44 patients with diabetes, hypertension and left ventricular hypertrophy died of sudden cardiac death. Substantially fewer deaths arose in the losartan group (14 out of 586) than in the atenolol group (30 out of 609). The results showed a close to 50% risk reduction in sudden death in losartan-treated patients compared with those treated with atenolol.

Lars Lindholm comments: "The reduction in sudden cardiac death with losartan was only evident for diabetic patients. These results are, however, exploratory, and require confirmation."

In an accompanying Commentary (p 591) Wilbert S Aronow from Westchester Medical Centre and New York Medical College, USA, concludes: "Lindholm and colleagues' new analysis, and their previous report, showing a significant reduction in cardiovascular mortality and in all-cause mortality by losartan compared with atenolol show that losartan is more effective than atenolol in treating hypertensive diabetic patients with left ventricular hypertrophy. However, a large double-blind randomised trial is necessary to investigate whether losartan is better, similar, or worse than propranolol, timolol, metoprolol, or carvedilol [all beta blockers] in reducing sudden cardiac death and coronary events."

Contact: Professor Lars Hjalmar Lindholm, Department of Public Health and Clinical Medicine, Umea University, SE 901 85, Umea, Sweden; T) 46-90-785-35-26; F) 46-90-77-68-83; E) LarsH.Lindholm@fammed.umu.se

Dr Wilbert S Aronow, Department of Medicine, Divisions of Cardiology and Geriatrics, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA; T) 1-914-493-5311; F) 1-914-235-6274; E) WSAronow@aol.com

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