COMMENTARY

VALIANT: Further Considerations and Clinical Implications

Eric J. Velazquez, MD

Disclosures

January 28, 2004

In This Article

Introduction

The initial results of the Valsartan in Acute Myocardial Infarction (VALIANT) trial were presented at the 2003 American Heart Association (AHA) meeting in Orlando, Florida, and published concurrently in The New England Journal of Medicine.[1] The trial demonstrated that the angiotensin receptor blocker (ARB) valsartan (Diovan; Novartis Pharmaceuticals, East Hanover, New Jersey) and the angiotensin-converting enzyme (ACE) inhibitor captopril are clinically "equivalent" for reducing rates of death and time to initial cardiovascular events in patients with acute myocardial infarction (AMI) complicated by heart failure and/or left ventricular dysfunction. Furthermore, VALIANT found that combining these 2 agents as an initial strategy in these high-risk patients did not provide incremental benefits.

This was an important result in an important subset of patients, and the results were both welcome and yet perhaps unanticipated. In the following discussion, we need to consider what the background to VALIANT was (ie, why did we want to test ARBs?), which patients qualify as "VALIANT patients," and how we can apply the results of this important trial to our clinical practice.

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