| アブストラクト | Background: Patients with heart failure with reduced ejection fraction (HFrEF) in Asia exhibit many differences from those in other parts of the world. Objectives: This study sought to investigate the efficacy and safety of dapagliflozin, compared with placebo, in HFrEF patients in Asia, compared with those elsewhere, enrolled in the DAPA-HF (Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure) trial. Methods: Patients in New York Heart Association functional class II to IV with a left ventricular ejection fraction </=40% and elevated N-terminal pro-B-type natriuretic peptide were eligible for the DAPA-HF trial. The primary outcome in the DAPA-HF trial was the composite of an episode of worsening HF (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death. Results: Of the 4,744 patients in the DAPA-HF trial, 1,096 (23.1%) were enrolled in Asia; 721 (15.2% overall, 65.8% of patients in Asia) were enrolled in East Asia (237 in China, 343 in Japan, and 141 in Taiwan), 138 (2.9% overall, 12.6% in Asia) in South-East Asia (Vietnam), and 237 (5.0% overall, 21.6% in Asia) in South Asia (India). Patients from Asia had similar rates of worsening HF events and mortality compared with patients elsewhere. Compared with placebo, dapagliflozin reduced the risk of the primary endpoint to the same extent in patients from Asia (HR: 0.65; 95% CI: 0.49 to 0.87) as elsewhere (HR: 0.77; 95% CI: 0.66 to 0.89) (P for interaction = 0.32). Consistent benefits were observed for the other prespecified outcomes and among the regions of Asia. Study drug discontinuation and prespecified adverse events did not differ between regions. Conclusions: Dapagliflozin, compared with placebo, reduced the risk of worsening HF events and cardiovascular death to the same extent in Asian patients as elsewhere. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124). |
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| 投稿者 | Docherty, Kieran F; Anand, Inder S; Chiang, Chern-En; Chopra, Vijay K; Desai, Akshay S; Kitakaze, Masafumi; Verma, Subodh; Vinh, Pham N; Inzucchi, Silvio E; Kober, Lars; Kosiborod, Mikhail N; Martinez, Felipe A; Bengtsson, Olof; Ponikowski, Piotr; Sabatine, Marc S; Sjostrand, Mikaela; Solomon, Scott D; Langkilde, Anna Maria; Jhund, Pardeep S; McMurray, John J V |
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| 組織名 | BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland,;United Kingdom.;Department of Cardiology, University of Minnesota, Minneapolis, USA.;Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital;and National Yang-Ming University, Taipei, Taiwan.;Department of Cardiology, Medanta, Gurgaon, India.;Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard;Medical School, Boston, Massachusetts, USA.;Cardiovascular Division of Medicine, National Cerebral and Cardiovascular Center,;Osaka, Japan.;Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto,;Ontario, Canada.;Department of Internal Medicine, Tan Tao University, Tan Duc, Vietnam.;Section of Endocrinology, Yale University School of Medicine, New Haven,;Connecticut, USA.;Department of Cardiology, Rigshospitalet Copenhagen University Hospital,;Copenhagen, Denmark.;Department of Cardiology, Saint Luke's Mid America Heart Institute, University of;Missouri-Kansas City, Kansas City, Missouri, USA.;National University of Cordoba, Cordoba, Argentina.;AstraZeneca, Gothenburg, Sweden.;Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.;TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's;Hospital and Harvard Medical School, Boston, Massachusetts, USA. |
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