{"id":"46096","type":"article","url":"https://hartvaat.nl/2026/04/03/warrior-trial-intensieve-medicamenteuze-behandeling-verbetert-de-uitkomsten-niet/","title":"WARRIOR-trial: intensieve medicamenteuze behandeling verbetert de uitkomsten niet bij vrouwen met ANOCA/INOCA","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004115?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004115?rss=1","authors":["Pepine","C. J.","Handberg","E.","Cooper-DeHoff","R.","Cook-Wiens","G.","Diniz","M. A.","Frayne","S.","Lo","M. C.","Smith","S. M.","Harris","B.","Wei","J.","Chaitman","B. R.","Spertus","J. A.","Berry","C.","Weintraub","W.","Bairey Merz","C. N."],"significance":7,"published":"2026-07-24","source_date":"2026-04-03","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"Women with angina referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA). The randomised WARRIOR trial (2,476 women, 71 US sites) tested whether intensive medical treatment (IMT: high-intensity statin, ACE inhibitor or ARB, and aspirin) reduces cardiovascular events (MACE) versus usual care. Recruitment was lower than planned, yielding an older population with well-controlled BP and LDL at baseline. At 2.5 years, 421 events occurred, with no difference in the primary endpoint (HR 1.13; p=0.20) or secondary outcomes; angina hospitalisations were the dominant contributor to MACE. IMT thus did not improve outcomes, though the trial was underpowered to exclude a possible benefit. The findings underscore the high disease burden and the need for better research in this population.","created":"2026-07-03T20:27:19Z","updated":"2026-07-04T19:09:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vrouwen met angina die voor coronairangiografie worden verwezen, blijken vaak geen obstructief coronairlijden te hebben (ANOCA/INOCA). De gerandomiseerde WARRIOR-trial (2.476 vrouwen, 71 Amerikaanse centra) onderzocht of intensieve medicamenteuze behandeling (IMT: hoge-intensiteitsstatine, ACE-remmer of ARB en aspirine) de cardiovasculaire events (MACE) vermindert vergeleken met gebruikelijke zorg. De inclusie viel lager uit dan gepland, met een oudere populatie en bij aanvang goed gereguleerde bloeddruk en LDL. Na 2,5 jaar traden 421 events op, zonder verschil in het primaire eindpunt (HR 1,13; p=0,20) of de secundaire uitkomsten; angina-opnames vormden de belangrijkste bijdrage aan MACE. IMT verbeterde de uitkomsten dus niet, al was de trial onvoldoende krachtig om een mogelijk voordeel uit te sluiten. De bevindingen onderstrepen de hoge ziektelast en de behoefte aan beter onderzoek bij deze groep.","abstract_original":"<sec><st>Importance</st>\n<p>Women with angina due to suspected ischaemia referred for coronary angiography often have no obstructive coronary artery disease (ANOCA/INOCA).</p>\n</sec>\n<sec><st>Objective</st>\n<p>To determine if intensive medical treatment (IMT) reduces major ischaemic events (major adverse cardiovascular event, MACE) among women with suspected ANOCA/INOCA.</p>\n</sec>\n<sec><st>Design</st>\n<p>Randomised, prospective, blinded-outcomes evaluation.</p>\n</sec>\n<sec><st>Setting</st>\n<p>71 sites in the USA.</p>\n</sec>\n<sec><st>Participants</st>\n<p>2476 women with suspected ANOCA/INOCA.</p>\n</sec>\n<sec><st>Interventions</st>\n<p>IMT-high intensity statin, ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) and aspirin versus usual care (UC).</p>\n</sec>\n<sec><st>Main outcomes and measures</st>\n<p>Primary: all cause death, myocardial infarction, stroke/transient ischaemic attack, hospitalisation for angina or heart failure (MACE). Secondary: components of the primary, quality of life and win ratio.</p>\n</sec>\n<sec><st>Results</st>\n<p>Recruitment was lower than planned (n=2476), yielding an aged population (mean, 64 years) with well-controlled blood pressure and low-density lipoprotein cholesterol at baseline, and relatively high rates of statin and ACEI/ARB use. At 2.5 years, 421 events occurred (221 in IMT, 200 in UC) with no difference in the primary outcome (HR=1.13 (95% CI 0.94 to 1.37) for IMT vs UC, p=0.20) or secondary outcomes. Hospitalisations for angina were the dominant contributor to MACE. Sensitivity analysis of contamination provided an estimated HR for IMT versus UC of 0.74 95% CI (0.352 to 1.558), p=0.43.</p>\n</sec>\n<sec><st>Conclusions and relevance</st>\n<p>Among women with suspected ANOCA/INOCA, outcomes were dominated by chest pain and IMT did not improve outcomes, although limited power precludes concluding that it may not be helpful. The findings support the need for more investigation in this population with high burden of angina hospitalisation, health resource consumption and poor quality of life.</p>\n</sec>\n<sec><st>Trial registration number</st>\n<p><A HREF=\"NCT03417388\">NCT03417388</A>.</p>\n</sec>"}