Journal ArticleDOI
Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction
Bertram Pitt,Willem J. Remme,Faiez Zannad,James D. Neaton,Felipe Martinez,Barbara Roniker,Richard Bittman,Steve Hurley,Jay H. Kleiman,Marjorie Gatlin +9 more
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TLDR
The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.Abstract:
background Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. methods Patients were randomly assigned to eplerenone (25 mg per day initially, titrated to a maximum of 50 mg per day; 3313 patients) or placebo (3319 patients) in addition to optimal medical therapy. The study continued until 1012 deaths occurred. The primary end points were death from any cause and death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia. results During a mean follow-up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (relative risk, 0.85; 95 percent confidence interval, 0.75 to 0.96; P=0.008). Of these deaths, 407 in the eplerenone group and 483 in the placebo group were attributed to cardiovascular causes (relative risk, 0.83; 95 percent confidence interval, 0.72 to 0.94; P = 0.005). The rate of the other primary end point, death from cardiovascular causes or hospitalization for cardiovascular events, was reduced by eplerenone (relative risk, 0.87; 95 percent confidence interval, 0.79 to 0.95; P=0.002), as was the secondary end point of death from any cause or any hospitalization (relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.98; P=0.02). There was also a reduction in the rate of sudden death from cardiac causes (relative risk, 0.79; 95 percent confidence interval, 0.64 to 0.97; P=0.03). The rate of serious hyperkalemia was 5.5 percent in the eplerenone group and 3.9 percent in the placebo group (P = 0.002), whereas the rate of hypokalemia was 8.4 percent in the eplerenone group and 13.1 percent in the placebo group (P<0.001). conclusions The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.read more
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Journal ArticleDOI
Single Intracoronary Injection of Encapsulated Antagomir-92a Promotes Angiogenesis and Prevents Adverse Infarct Remodeling
Neus Bellera,Ignasi Barba,Antonio Rodríguez-Sinovas,Eulalia Ferret,Miguel Angel Asin,MªTeresa Gonzalez‐Alujas,Jordi Pérez-Rodon,Marielle Esteves,Carla Fonseca,Nuria Toran,Bruno García del Blanco,Amadeo Perez,David Garcia-Dorado +12 more
TL;DR: Early single intracoronary administration of encapsulated antagomir‐92a in an adult pig model of reperfused AMI prevents left ventricular remodeling with no local or distant adverse effects, emerging as a promising therapeutic approach to translate to patients who suffer a large AMI.
Journal ArticleDOI
Opposite Predictive Value of Pulse Pressure and Aortic Pulse Wave Velocity on Heart Failure With Reduced Left Ventricular Ejection Fraction: Insights From an Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Substudy
Véronique Regnault,Jeremy Lagrange,Anne Pizard,Michel E. Safar,Renaud Fay,Bertram Pitt,Pascal Challande,Patrick Rossignol,Faiez Zannad,Patrick Lacolley +9 more
TL;DR: The results suggest that pulse pressure, being negatively associated with outcome, is more dependent on left ventricular function and thereby no longer a marker of aortic elasticity, in contrast, increased aorti stiffness, assessed by PWV, contributes significantly to cardiovascular death.
Journal ArticleDOI
Treatment for chronic heart failure in the elderly: current practice and problems.
Pasquale Abete,Gianluca Testa,David Della-Morte,Gaetano Gargiulo,Gianluigi Galizia,Domenico de Santis,A. Magliocca,Claudia Basile,Francesco Cacciatore +8 more
TL;DR: Self-care management, caregiver training, and multidimensional team represent the critical point of the treatment for CHF elderly patients.
Journal ArticleDOI
Clinical and genetic correlates of serum aldosterone in the community: the Framingham Heart Study.
Sekar Kathiresan,Martin G. Larson,Emelia J. Benjamin,Diane Corey,Joanne M. Murabito,Caroline S. Fox,Caroline S. Fox,Peter W.F. Wilson,Nader Rifai,James B. Meigs,Gesa Ricken,Richard P. Lifton,Daniel Levy,Daniel Levy,Ramachandran S. Vasan +14 more
TL;DR: Clinical variables related to higher serum aldosterone level included female sex, diuretic treatment, and a higher total/high density lipoprotein cholesterol ratio, while the genetic contribution to serum a Aldosterone level was modest.
Journal ArticleDOI
Effects of Drospirenone/17-β Estradiol on Blood Pressure and Potassium Balance in Hypertensive Postmenopausal Women*
Richard A. Preston,William B. White,Bertram Pitt,George L. Bakris,Paul M. Norris,Vladimir Hanes +5 more
TL;DR: In hypertensive postmenopausal women, treatment with DRSP/E2 was not associated with a greater incidence of hyperkalemia than with placebo in patients with and without type 2 diabetes mellitus and concomitant use of ACE inhibitors, angiotensin receptor antagonists, or ibuprofen.
References
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Donald W. Cockcroft,M H Gault +1 more
TL;DR: A formula has been developed to predict Creatinine clearance from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr (mg/100ml) (15% less i).
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The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.
Bertram Pitt,Faiez Zannad,Willem J. Remme,Robert J. Cody,Alain Castaigne,Alfonso Perez,Jolie Palensky,Janet Wittes +7 more
TL;DR: Blockade of aldosterone receptors by spironolactone, in addition to standard therapy, substantially reduces the risk of both morbidity and death among patients with severe heart failure.
Journal ArticleDOI
The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure
Bertram Pitt,Faiez Zannad,Willem J. Remme,Robert J. Cody,Alain Castaigne,Alfonso Perez,Jolie Palensky,Janet Wittes +7 more
The effect of spironolactone on morbidity and mortality in patients with severe heart failure
B Ertram P Itt,F Aiez Z Annad,J. R Emme,R Obert C Ody,A Lain C Astaigne,A Lfonso P Erez,J Olie P Alensky,J Anet W Ittes +7 more
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Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial.
TL;DR: In patients treated long-term after an acute myocardial infarction complicated by left-ventricular systolic dysfunction, carvedilol reduced the frequency of all-cause and cardiovascular mortality, and recurrent, non-fatal myocardia infarctions.
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