Heart failure & cardiomyopathiesSecondary analysis
Race in Heart Failure
- Pooled secondary analysis of the PARADIGM-HF and PARAGON-HF randomised trials
- subgroup analysis by self-reported race
- global
Authors' conclusion
In a pooled experience of 2 global trials, Black and Asian patients exhibited a higher risk of cardiovascular events than White patients. The benefits of sacubitril/valsartan were consistent across races. Risks of severe angioedema were low but numerically higher with sacubitril/valsartan.
Study context
- Population
- Patients with heart failure (HF) and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF)
- Participants
- 12,097 patients · 2 pooled RCTs
- Comparison
- Sacubitril/valsartan vs renin-angiotensin system inhibitor (RASi), by race
- Whiten = 9,451reference
- Asiann = 2,116
- Blackn = 530
Primary result
As reported in the abstract
Sacubitril/valsartan vs RASi on primary endpoint, by race
Sacubitril/valsartan vs RASiHazard ratio (95% CI)
White
0.84(0.77–0.91)
Asian
0.92(0.78–1.10)
Black
0.79(0.58–1.07)
Further findings
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Primary outcome risk by race (vs White) · median follow-up 2.5 years — Black vs White | 1.68 (1.42–1.98) | |
| Primary outcome risk by race (vs White) · median follow-up 2.5 years — Asian vs White | 1.32 (1.18–1.47) | |
| 0.512Adjusted hazard ratio (log scale) |
Safety
Severe angioedema, sacubitril/valsartan vs RASi, by race
- White
- 0.2% vs 0.1%
- Black
- 1.5% vs 0.0%
- Asian
- 0.1% vs 0.1%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Race in Heart Failure. JACC Heart Fail. Published 31 August 2024. doi:10.1016/j.jchf.2024.08.008
Summarised from the published abstract; every number is checked against it