The Carvedilol and ACE-inhibitor Remodelling Mild Heart Failure EvaluationTrial (CARMEN) - Rationale and design

Inhibition or reversal of ventricular remodelling in heart failure patients is regarded as of prime importance in the treatment of heart failure and i n determining long term outcome. Recent studies have demonstrated that the addition of carvedilol to Angiotensin Converting Enzyme (ACE) inhibitors an d other routine heart failure therapy results in a valuable improvement in the clinical status and life expectancy of mild, moderate and severe heart failure patients. ACE inhibitors have become the cornerstone of heart failu re therapy. Also, carvedilol in combination with standard therapy (includin g ACE inhibitors) has demonstrable beneficial effects on left ventricular r emodelling. Each new treatment has to be added, this quickly leads to polyp harmacy, which may not be necessary and even unwanted in the individual pat ient, as the pharmacological profile of carvedilol compares favourably to A CE inhibitors, this suggests that it could challenge ACE inhibitors as firs t-line treatment for heart failure. The CARMEN trial (Carvedilol and ACE-Inhibitor Remodelling Mild Heart Failu re EvaluatioN) was designed to compare the effects of carvedilol alone and of carvedilol plus an ACE inhibitor (enalapril) with the effect of an ACE i nhibitor alone on different parameters of left ventricular remodelling as w ell as morbidity and mortality in patients with chronic mild heart failure, thereby allowing conclusions on whether combination therapy may be replace d by the multiple action adrenergic inhibitor carvedilol in the future.