Death risk fell 62% in study of experimental congestive heart failure drug Hopes brighten for many patients

July 15, 1993|By Holly Selby ((TC | Holly Selby ((TC,Staff Writer

The lives of many people suffering from congestive heart failure could be prolonged by an experimental drug, researchers announced yesterday.

The risk of death decreased 62 percent among patients who took the drug for six months, said Dr. Arthur Feldman, associate professor of cardiology at the Johns Hopkins University School of Medicine and a director of the study, published in this week's New England Journal of Medicine.

"We don't know the effects over two or three years, but our suspicion is that the positive effects will continue," he said.

The drug, vesnarinone, offers hope of prolonging and improving the quality of the lives of many of the 3.5 million Americans with congestive heart failure.

Some health professionals said the drug warranted further investigation but questioned its promise.

An editorial in the journal written by Dr. Milton Packer of Columbia University challenges, among other things, the way researchers evaluated patients' "quality of life."

But Robert Moon, a 55-year-old Columbia architect attending a Hopkins news conference announcing study results, said the drug prolonged his life after he began taking it in February 1992.

He said vesnarinone also alleviated his fatigue and improved his general feeling of wellness by giving him hope. But it was not a cure. His heart has deteriorated, and he is now waiting for a heart transplant.

Vesnarinone works by promoting more powerful contractions of the heart muscle without increasing the heart rate. Other medicines that cause more powerful contractions also cause the heart to pump faster, Dr. Feldman said.

Vesnarinone also opens up the large arteries, facilitating blood flow, and has what Dr. Feldman termed "novel ancillary properties," the ability to promote survival.

Early studies indicated that dosage was a critical factor. The death rate was higher among patients who received 120-milligram daily doses than among those who received the 60-milligram doses in the study reported on yesterday. A wider study under way at Hopkins and 72 other sites is investigating the possible benefits at 30 milligrams a day.

"The drug is clearly interesting, and it may have great potential. But there are still major questions as to how it works, who will benefit and who will be harmed by it," said Dr. Stephen Gottlieb, director of the cardiac care unit at the University of Maryland School of Medicine.

Congestive heart failure, in which the heart muscle doesn't function adequately, affects about 6 percent of all Americans over age 65.

Half of those who have congestive heart failure die within one year of diagnosis, and 80 percent to 90 percent die within five years.

In the study at 22 medical centers nationwide, 239 patients each took 60 milligrams of vesnarinone daily and 238 took placebos. Both groups also took regular medicines including blood vessel dilators, heart muscle contractors and diuretics.

In another part of the study, 87 patients were given 120 milligrams of vesnarinone a day. It was discontinued when it was determined that the higher dosage increased the mortality rate. Sixteen patients died.

Among those taking 60 milligrams, fewer died than would have been expected -- 13, compared with 33 taking placebos. Eighteen others taking 60 milligrams experienced deteriorating heart conditions, compared with 33 taking placebos.

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