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Not All Heart Failure Drugs Boost Survival Equally

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 11 (HealthDay News) -- Over the course of five years, heart failure patients taking the blood pressure drug candesartan stood a higher chance of survival than those taking losartan did, Swedish researchers report.

In fact, 61 percent of those taking candesartan (Atacand) survived, compared with 44 percent of those taking losartan (Cozaar); this difference may be due to differences in the way the drugs work, the study authors noted.

"Heart failure is among our most common causes of death and hospitalization," said lead researcher Dr. Lars H. Lund, an associate professor in the department of cardiology at Karolinska University Hospital in Stockholm.

Both drugs belong to an important group of medications known as angiotensin II receptor blockers (ARBs) that decrease mortality and hospitalization in heart failure patients, he added. However, the efficacy of different drugs in this class appears to vary.

"Previously, it was believed that the particular type of angiotensin receptor blocker did not matter," Lund explained. "Here we show that candesartan is associated with less mortality than losartan in heart failure."

The report is published in the Jan. 12 issue of the Journal of the American Medical Association.

For the study, Lund's group collected data on 5,139 patients. Among these, 2,639 were treated with candesartan and 2,500 received losartan.

The researchers also found that one-year survival for those taking candesartan was 90 percent, while for those taking losartan it was 83 percent.

Based on these findings, Lund expects prescribing habits to change in favor of candesartan.

"Prescription of candesartan will probably increase and of losartan decrease. But this may be controversial, because candesartan is on patent and relatively expensive, whereas losartan is generic and much less expensive," he said.

For patients without prescription drug coverage, losartan has recently become available as a generic medication and costs $1 to $2 a day, according to Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles. Candesartan is a branded medication and costs $3 a day, he added.

Fonarow noted that "an ACE inhibitor is the first-line, guideline-recommended therapy for patients with heart failure. Losartan and candesartan are recommended for use in heart failure patients only if an ACE inhibitor is not well-tolerated. There are numerous generic options for ACE inhibitors, and these may cost as little as 10 cents a day."

Moreover, the comparative effectiveness of different angiotensin receptor blockers has not been studied extensively in patients with heart failure. However, trials with candesartan have been larger and more positive than studies conducted with losartan, Fonarow added.

More information

For more information on heart failure, visit the American Heart Association.

SOURCES: Lars H. Lund, M.D., Ph.D., associate professor, department of cardiology, Karolinska University Hospital, Stockholm, Sweden; Gregg Fonarow, M.D., American Heart Association spokesman and professor, cardiology, University of California, Los Angeles; Jan. 12, 2011, Journal of the American Medical Association

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