Issue 170 Item 5 Losartan Reduces Sudden Cardiac Death Risk in Diabetics

Losartan may better protect diabetics against cardiac death from arrhythmias than atenolol.

Findings from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.

Dr. Lars H. Lindholm, of Ume University Hospital in Sweden, and other members of the LIFE study group previously found that losartan-based antihypertensive treatment was superior to atenolol in reducing all-cause mortality in diabetics. They conducted a post-hoc analysis using the same data to examine sudden cardiac death rates among diabetics with hypertension and left ventricular hypertrophy.

"Results of our post-hoc analysis showed a close to 50% risk reduction in sudden death in losartan-treated patients with diabetes compared with those treated with atenolol," writes Professor Lars H. Lindholm, MD, of Umea University Hospital, Sweden and colleagues. They studied 586 patients taking once daily losartan versus 609 patients undergoing an atenolol-based antihypertensive therapy. The patients, 53% women, were a mean age of 67 years and diabetic, with left ventricular hypertrophy and an average blood pressure of 177/96 mm Hg.

After a mean follow up of 4.7 years the researchers report that 44 patients died of sudden cardiac death, 14 (2%) in the losartan group compared with 30 (5%) in the atenolol group.

Among 191 patients with atrial fibrillation at baseline or during the trial, 10% experienced sudden cardiac death compared with 2% of the 1004 patients without atrial fibrillation. In the losartan group 5 of the 86 patients (6%) with atrial fibrillation at baseline or during the trial experienced sudden cardiac death compared with 9 of the 500 patients (2%) without atrial fibrillation. Among the atenolol group 14 of the 105 patients (13%) with atrial fibrillation compared with 16 of 504 patients (3%) without atrial fibrillation experienced sudden cardiac death.

In the losartan-treated patients the findings of reduced risk were independent of other risk factors for sudden cardiac death, but the researchers note that their analyses "were exploratory and require confirmation."

Dr. Lindholm’s team suggests that losartan has a better anti-arrhythmic property than atenolol. However, "our analyses were exploratory and require confirmation," they note.
In an accompanying commentary, Dr. Wilbert S. Aronow, of New York Medical College, Valhalla, points out that lipophilic beta blockers–propranolol, timolol, metoprolol and carvedilol–also reduce sudden cardiac death, whereas the hydrophilic beta blocker atenolol does not.
Therefore, he maintains that a large, double-blind, randomized trial will be required to determine how losartan compares with these agents in reducing sudden cardiac death and coronary events.