Recent studies have suggested that an-giotensin-converting enzyme (ACE) inhibitors do not work as well in African-American patients as in white patients. Researchers from the University of Texas and Loyola University, however, take issue with those findings.
Based on their own retrospective analysis of data from 403 African-American and 3,651 white participants in the Studies of Left Ventricular Dysfunction Prevention Trial, they say that ethnicity does not influence the effectiveness of at least one ACE inhibitor, enalapril.
The researchers were concerned that the publicity surrounding ACE inhibitors and race might dissuade clinicians from using a life-saving drug for their black patients. However, in their study, they found that canadian enalapril worked equally well in both groups, both in reducing the need for medications for heart failure symptoms and reducing the risk of developing heart failure or dying from it.
That’s not to say that blacks are not still at higher risk for symptomatic heart failure than whites. Studies have shown that even after adjusting for differences in severity of symptoms, comorbidities, and socioeconomic factors, blacks have a substantially greater absolute risk for progression from asymptomatic LVD to symptomatic HF, the researchers note. And, despite the comparable relative reduction in risk associated with enalapril in both whites and blacks, the differences in the baseline magnitude of risk was such that blacks randomized to enalapril remained at higher risk than whites randomized to placebo. The differences between black and white patients in the risk of progression of ALVD persisted after the researchers adjusted for potential con-founders such as ejection fraction, NYHA class, serum sodium, and etiology of LV dysfunction.
The researchers interpret their findings as suggesting either that residual confounding exists or that there are differences in the natural history of ALVD in blacks and whites.