MUNICH — The disappointing performance of the angiotensin receptor blocker telmisartan for prevention of cardiovascular events and new-onset diabetes in the nearly 6,000-patient TRANSCEND trial leaves the ACE inhibitors securely ensconced as agents of choice, cardiologists agreed at the annual congress of the European Society of Cardiology.
TRANSCEND (Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease) involved 5,926 ACE inhibitor-intolerant patients who had established coronary, cerebral, or peripheral vascular disease, or diabetes with end-organ damage, at 630 participating hospitals in 40 countries. More than 2,100 subjects were diabetic. Participants were randomized in a double-blind fashion to 80 mg/day of telmisartan (Micardis) or placebo, and were followed for a median of 56 months, said Dr. Karl Swedberg, professor of medicine at Göteborg (Sweden) University.
Dr. Koon Teo reported that the primary composite end point—cardiovascular death, MI, stroke, or hospitalization for heart failure—occurred in 15.7% of the telmisartan group and 17.0% of those on placebo, a statistically nonsignificant difference.
The outcome curves did not diverge until the 2-year mark. After that, the difference steadily widened, said Dr. Teo, a member of the trial's steering committee and professor of medicine at McMaster University, Hamilton, Ont. Dr. Teo disclosed receiving consulting and lecture fees as well as research grants from Boehringer Ingelheim GmbH, sponsor of TRANSCEND, PRoFESS, and ONTARGET.
As Dr. Teo presented the TRANSCEND results at the European congress, the study was simultaneously published online (Lancet 2008 [doi:10.1016/S0140–6736(08)61242–8]).