From the Guidelines
Optimal medical therapy, including ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRA), is recommended for patients with dilated cardiomyopathy to reduce the risk of sudden death and progressive heart failure. This approach is based on the most recent and highest quality evidence, which emphasizes the importance of a comprehensive treatment strategy to manage symptoms, prevent complications, and slow disease progression 1.
Key Components of Treatment
- ACE inhibitors, such as enalapril or lisinopril, to reduce blood pressure and decrease the heart's workload
- Beta-blockers, such as carvedilol or metoprolol succinate, to slow the heart rate and improve heart function
- Mineralocorticoid receptor antagonists (MRA), such as spironolactone, for patients with reduced ejection fraction below 35%
- Diuretics, like furosemide, to manage fluid retention
- SGLT2 inhibitors, such as dapagliflozin, for patients with heart failure, regardless of diabetes status
Additional Interventions
- Implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death in patients with non-ischemic dilated cardiomyopathy or ischemic heart disease 1
- Cardiac resynchronization therapy (CRT) for electrical coordination in patients with advanced heart failure
- Mechanical circulatory support or heart transplantation for end-stage disease
Lifestyle Modifications
- Sodium restriction (less than 2-3 grams daily)
- Fluid restriction if needed
- Regular moderate exercise as tolerated
- Avoiding alcohol and tobacco
These treatments and lifestyle modifications work together to reduce the workload on the heart, prevent harmful remodeling, improve cardiac output, and reduce the risk of life-threatening arrhythmias, ultimately improving morbidity, mortality, and quality of life for patients with dilated cardiomyopathy.
From the FDA Drug Label
In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose
The treatment for dilated cardiomyopathy may include lisinopril, as it has been shown to reduce signs and symptoms of heart failure when used in combination with digitalis and diuretics. Key benefits of lisinopril in this context include:
- Reduction of edema, rales, paroxysmal nocturnal dyspnea, and jugular venous distention
- Improvement in exercise tolerance
- Reduction in orthopnea, presence of third heart sound, and number of patients classified as NYHA Class III and IV Lisinopril may be used at a dose of up to 20 mg daily. However, the optimal dosage and treatment strategy should be determined by a healthcare professional based on individual patient needs and medical history 2.
From the Research
Treatment Options for Dilated Cardiomyopathy
The treatment for dilated cardiomyopathy (DCM) typically involves a combination of medications and lifestyle changes. Some of the key treatment options include:
- Angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to improve left ventricular function and reduce cardiovascular events 3
- Beta-blockers to slow the progression of disease and improve quality and length of life 4, 5, 6
- Diuretics and mineralocorticoid receptor antagonists to manage symptoms of heart failure 4, 7
- Digoxin for patients with atrial fibrillation or severe heart failure 4, 7
- Ivabradine for patients with sinus rhythm and a high pulse rate 4, 5
Medication Combinations and Efficacy
Studies have shown that combining different medications can increase the clinical effectiveness of treating DCM. For example:
- A network meta-analysis found that carvedilol, verapamil, and trimetazidine were the top three medicines for improving left ventricular ejection fraction (LVEF) 5
- Ivabradine, bucindolol, and verapamil were found to be effective in improving left ventricular end-diastolic dimension (LVEDD) 5
- Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with DCM 5, 6
Patient-Specific Treatment Considerations
Treatment for DCM should be individualized based on the patient's specific needs and medical history. For example: