Candesartan has a significantly lower risk of death at one to five years than losartan when given to patients with heart failure, Swedish researchers wrote in JAMA (Journal of the American Medical Association). Candesartan and losartan are angiotensin II receptor blockers, also known as ARBs – they are known to reduce cardiovascular mortality and heart failure hospitalization in patients with heart failure with LVEF (reduced left ventricular ejection faction). LVEF is a measure of how effectively the left heart ventricle pumps each time it contracts.

Scientists have known that ARBs have varying effects on the patient. Despite this, no head-to-head test has ever been done. The authors explain that many believe ARBs differ in efficacy. According to previous research, losartan was linked to higher mortality for elderly patients with heart failure, compared to other ARBs.

Dr. Maria Eklind-Cervenka, from the Department of Cardiology, South Hospital, Stockholm, and team set out to find out whether candesartan might be linked to fewer deaths for any reason (all-cause mortality) than losartan among individuals with heart disease.

They gathered and examined data from the Swedish Heart Failure Registry, involving 30,254 patients registered from 60 outpatient clinics and 62 patients from the beginning of 2000 through 2009. 2,639 patients received candesartan and 2,500 received losartan.

They found that:

  • 90% of the candesartan patients survived for at least one year
  • 83% of the losartan patients survived for at least one year
  • 61% of the candesartan patients survived for at least five years
  • 44% of the losartan patients survived for at least five years

The difference in survival rates “persisted in stratified analyses.”

Candesartan studies have been larger than the losartan ones, the authors added. The candesartan studies have also compared more favorably than the losartan ones.

The authors concluded:

“In conclusion, our findings suggest that candesartan is associated with less all-cause mortality than losartan. However, clinical decision making should await supportive evidence of this observed association. Ideally, different ARB agents should be tested against each other in randomized controlled trials. It would also be important and perhaps more feasible to confirm our findings in other large HF registries.”

When a patient has heart failure their heart is not pumping blood around the body properly. Either the left, right, or both sides of the body can be affected. Symptoms, which can be severe, usually depend on which side of the body is affected.

Lay people often confuse the meanings of heart attack, heart failure, and cardiac arrest.

  • Heart attack – the heart muscle dies, caused by a blockage (occlusion) of a coronary artery. The heart muscle becomes starved of oxygen because not enough blood is getting to it.
  • Heart failure – the heart muscle is not pumping blood around the body properly/effectively. Heart failure is not a heart attack.
  • Cardiac arrest – the heart stops, blood circulation stops, the heartbeat stops, there is no pulse.

“Association of Candesartan vs Losartan With All-Cause Mortality in Patients With Heart Failure”
Maria Eklind-Cervenka, MD, Lina Benson, MSc, Ulf Dahlström, MD, PhD, Magnus Edner, MD, PhD, Mårten Rosenqvist, MD, PhD, Lars H. Lund, MD, PhD
JAMA. 2011;305(2):175-182. doi: 10.1001/jama.2010.1949

Written by Christian Nordqvist