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    "textoCompleto" => "NEFROLOGÍA. Vol. XXIV. Número Extraordinario (I). 2004 Efecto del losartán sobre la muerte cardíaca súbita en personas con diabetes: estudio LIFE L. Lindholm Umea University Hospital. Sweden. Sudden cardiac death prevention in coronary heart disease is an important goal for treatment. In placebo controlled long-term studies, several beta-blockers including atenolol have shown consistent reductions in post-infarction mortality by up to 50% reduction in the risk of sudden cardiac death 1. It has been suggested that in patients with diabetes mellitus, particularly if associated with autonomic neuropathy, increase in heart rate and decrease in heart rate variability may be critical risk factors for sudden cardiac death and increased all-cause mortality. 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In both groups, around 85% received a diuretic as supplementary treatment. Cox regression analysis with baseline Framingham risk score and ECG-LVH as covariates was used to compare effects of the two regimens on cardiovascular morbidity and mortality (defined as cardiovascular death, stroke, or myocardial infarction). An independent end-point committee, masked to the type of treatment the patients had received, classified all endpoints including sudden cardiac death. As previously reported 1, there were fewer (p = 0.028) cardiovascular deaths in the losartan group than in the atenolol group and there was a similar tendency (p = 0.052) for coronary deaths. When analysed separately, there was significantly less (p = 0.027) sudden cardiac deaths in the losartan-based group (14 patients) than in the atenolol-based group (30 patients), as shown in table I and figure 1. This tended to be so, regardless of whether deaths occurred within one hour or within 24 hours of symptom onset (table I). Our finding that the risk was lower in the losartan-treated diabetics than in those who received atenolol was independent of other risk factors for sudden cardiac death. A difference in regression of LVH between the two treatment groups of diabetics did not explain the difference in sudden cardiac death. The last serum potassium value before sudden death (mean and standard deviation) was similar, 4.26 (0.42) mmol/L in the losartan-based group and 4.23 (0.40) mmol/L in the atenolol-based group (NS)&#59; the change from baseline was 0.01 mmol/L in both groups. In the non-diabetics of the LIFE trial, there were equal numbers of sudden cardiac deaths (67 patients) in the two treatment groups. The results from the diabetic subgroup in the LIFEstudy, showing a much lower rate of cardiovascular death and total death in losartan-treated patients than in atenolol-treated patients 5, prompted us to carry out a post-hoc analysis of sudden cardiac death. 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LINDHOLM group were 5 of 86 (6%) vs 9 of 500 (2%) and in the atenolol group 14 of 105 (13%) vs 16 of 504 (3%). Study drug discontinuation, particularly discontinuation of atenolol, did not explain these differences. It should be underlined that the number of sudden cardiac deaths (n = 44) in the present analyses comprised 44% of all cardiovascular deaths and 26% of all deaths in the LIFE diabetics during follow-up. It is known from experimental studies, as well as analyses of the LIFE study, that losartan as compared to atenolol reduced the risk of episodes of atrial fibrillation. It is likely that losartan, by leading to regression of left ventricular hypertrophy and possibly less atrial fibrosis, would favor an anti-arrhythmic effect. It is also known from the LIFE study that abnormalities in QT-dispersion and heart rate variability are related to left ventricular hypertrophy, possibly by left ventricular hypertrophy-induced repolarization abnormalities. 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Curr Cardiol Rep 4: 426-33, 2002. 5. Lindholm LH, Ibsen H, Dahlöf B y cols.: Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359: 100410, 2002. 12 "
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2019 Diciembre 48 27 75
2019 Noviembre 64 18 82
2019 Octubre 28 9 37
2019 Septiembre 43 17 60
2019 Agosto 27 14 41
2019 Julio 29 25 54
2019 Junio 23 14 37
2019 Mayo 25 35 60
2019 Abril 57 39 96
2019 Marzo 15 15 30
2019 Febrero 10 30 40
2019 Enero 17 16 33
2018 Diciembre 34 26 60
2018 Noviembre 43 14 57
2018 Octubre 36 9 45
2018 Septiembre 28 10 38
2018 Agosto 18 10 28
2018 Julio 22 15 37
2018 Junio 17 7 24
2018 Mayo 17 11 28
2018 Abril 28 5 33
2018 Marzo 17 7 24
2018 Febrero 19 3 22
2018 Enero 20 5 25
2017 Diciembre 27 3 30
2017 Noviembre 14 3 17
2017 Octubre 22 5 27
2017 Septiembre 11 4 15
2017 Agosto 13 6 19
2017 Julio 14 5 19
2017 Junio 8 5 13
2017 Mayo 16 5 21
2017 Abril 14 3 17
2017 Marzo 15 2 17
2017 Febrero 6 0 6
2017 Enero 9 2 11
2016 Diciembre 12 10 22
2016 Noviembre 26 7 33
2016 Octubre 29 4 33
2016 Septiembre 56 2 58
2016 Agosto 71 1 72
2016 Julio 89 2 91
2016 Junio 69 0 69
2016 Mayo 69 0 69
2016 Abril 43 0 43
2016 Marzo 27 0 27
2016 Febrero 57 0 57
2016 Enero 47 0 47
2015 Diciembre 65 0 65
2015 Noviembre 64 0 64
2015 Octubre 43 0 43
2015 Septiembre 40 0 40
2015 Agosto 42 0 42
2015 Julio 33 0 33
2015 Junio 23 0 23
2015 Mayo 23 0 23
2015 Abril 7 0 7
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