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
Reads0
Chats0
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
Citations
More filters
Journal ArticleDOI
Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure.
João Pedro Ferreira,Mário Santos,Sofia Almeida,Irene Marques,Paulo Bettencourt,Henrique Carvalho +5 more
TL;DR: This study supports the safety of high dose spironolactone in ADCHF and suggests a positive impact in the resolution of congestion and the important findings of this pilot study need to be confirmed in larger trials.
Journal ArticleDOI
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
TL;DR: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality and other relevant databases as discussed by the authors .
Journal ArticleDOI
Neutrophil Gelatinase-Associated Lipocalin, a Novel Mineralocorticoid Biotarget, Mediates Vascular Profibrotic Effects of Mineralocorticoids.
Antoine Tarjus,Ernesto Martínez-Martínez,Cristián A. Amador,Celine Latouche,Soumaya El Moghrabi,Thorsten Berger,Tak W. Mak,Renaud Fay,Nicolette Farman,Patrick Rossignol,Faiez Zannad,Natalia López-Andrés,Frederic Jaisser +12 more
TL;DR: Results showed that Lcn2 plays a key role in aldosterone/mineralocorticoid receptor–mediated vascular fibrosis, and clinical data indicate that this may translate in human patients.
Journal ArticleDOI
Effects of Aldosterone and Angiotensin II Receptor Blockade on Cardiac Angiotensinogen and Angiotensin-Converting Enzyme 2 Expression in Dahl Salt-Sensitive Hypertensive Rats
Yoshiyu Takeda,Aoshuang Zhu,Takashi Yoneda,Mikiya Usukura,Hiroyuki Takata,Masakazu Yamagishi +5 more
TL;DR: In DS rats, blockade of aldosterone or Ang II protects cardiac hypertrophy and fibrosis by inactivation of the local RAAS in the heart.
Journal ArticleDOI
Hyperkalaemia and impaired renal function in patients taking spironolactone for congestive heart failure: retrospective study
TL;DR: Spironolactone reduces disease and death in patients with severe congestive heart failure and is well tolerated with regard to renal function and serum potassium concentrations, but it can lead to renal dysfuction or hyperkalaemia.
References
More filters
Journal ArticleDOI
Prediction of Creatinine Clearance from Serum Creatinine
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).
Journal ArticleDOI
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
Journal ArticleDOI
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.
Related Papers (5)
Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. results of the survival and ventricular enlargement trial
Marc A. Pfeffer,Eugene Braunwald,Lemuel A. Moyé,Lofty L. Basta,Edward J. Brown,Thomas E. Cuddy,Barry R. Davis,Edward M. Geltman,Steven Goldman,Greg C. Flaker,Marc Klein,Gervasio A. Lamas,Milton Packer,Jacques R. Rouleau,Jean L. Rouleau,John D. Rutherford,John H. Wertheimer,C. Morton Hawkins +17 more
Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)
Åke Hjalmarson,Sidney Goldstein,Björn Fagerberg,Hans Wedel,Finn Waagstein,John Kjekshus,John Wikstrand,G. Westergren,M. Thimell,D. El Allaf,Jiri Vitovec,J. Aldershvile,M. Halinen,Rainer Dietz,K. L. Neuhaus,András Jánosi,Gudmundur Thorgeirsson,P. Dunselman,Lars Gullestad,J. Kuch,Johan Herlitz,Peter Rickenbacher,Stephen G. Ball,Stephen S. Gottlieb,Prakash Deedwania,G. Vandenhoven,I. Nováková,S. Danker,M. Lundström,W. Meyer-Sabellek,I. Balla,M. Sveinsdottir,B. Dorhout,A. Hildebrandt,I. Szczurko,C. Larsson,E. Bucher,E. Scott,D. Dwyer,D. G. Julian,David L. DeMets,K. Chatterjee,J. Feyzi,S. Lehto,P. Karpati,W. Motz,O. Samuelsson,J. W. Viersma,B. Andersson,C. Berthe,J. M. Boutefeu,G. Boxho,P. Decroly,J. P. Derbaudrenghien,J. Pirlet,Philip D. Henry,G. Heyndrickx,L. Missault,M. Nannan,P. Timmermans,J. L. Vachiery,W. Van Mieghem,J. L. Vandenbossche,K. Dvorák,M. Herold,Jaromír Hradec,A. Kána,P. Petr,J. Rybka,J. Smíd,P. Svítil,J. Toman,E. Agner,O. Amtorp,K. Egstrup,P. Eliasen,C. O. Gotzsche,P. Hildebrandt,A. Johannesen,P. Kaiser-Nielsen,H. Nielsen,P. E. Nielsen,F. Pedersen,J. Rokkedal Nielsen,K. Skagen,T. Honkanen,E. Hussi,J. Juvonen,H. Jääskeläinen,J. Rinne,T. Salonen,D. Andresen,H. Berwing,Bethge,Beythien,Bischoff,Bundschu,Daniel,Darius,Delius,Drude,Dingerkus,Dück,Eichler,Fach,A. Förster,Girth,Goss,Hahn,Hambrecht,G. F. Hauf,Heinemann,Hepp,Janka,Klocke,Konz,B. Krosse,Kühlkamp,Lewek,B. Lüderitz,Löbe,Maier,Melchior,Müller,Mäurer,Nast,Neuhaus,Obst,Odemar,K. E. von Olshausen,Pomykaj,K. J.G. Schmailzl,Schrader,Schröder,P. L. Schwimmbeck,M. Sigmund,Simon,Strasser,Thilo,Vöhringer,H. Völler,Weibrodt,Wirtz,István Czuriga,M. Hetey,A. Katona,M. Lengyel,A. Nyárádi,A. Rednik,K. Sándori,P. Szabó,J. Tarján,J. Tenczer,S. Timar,P. Vályi,G. Veress,K. Zámolyi,B. Oze,Ge Thorgeirsson,Gu Thorgeirsson,P. J.L.M. Bernink,A. C. Bredero,R. Breedveld,P. N.W.M. Breuls,J. J.J. Bucx,Jan H. Cornel,P. A. de Milliano,Peter H.J.M. Dunselman,B. J.B. Hamer,N. Holwerda,J. Hoogsteen,J. C.A. Hoorntje,Johannes A. Kragten,A. H. Liem,G. Linssen,H. R. Michels,A. R. Ramdat Misier,H. J. Schaafsma,P. Sijbring,R. J.T. Taverne,L. H.J. Van Kempen,R. Van Stralen,P. J. Van Veldhuisen,M. J. Veerhoek,C. J.P.J. Werter,J. C.L. Wesdorp,A. R. Willems,A. J.A.M. Withagen,P. A.G. Zwart,R. Bjornerheim,M. Dahle,Kenneth Dickstein,G. S. Froland,T. Gundersen,K. Hofsoy,T. L. Hole,T. Johansen,J. Mannsverk,P. Nesje,T. M. Omland,C. Sjödin,Peter K. Smith,H. A. Tjonndal,O. Vikesdal,K. Waage,Adamus,K. Jaworska,P. Kolodziej,Z. Kornacewicz-Jach,M. Krzemiñska-Pakula,J. W. Piotrowski,W. Piwowarska,A. Stogowski,J. Wodniecki,K. Wrabec,P. Ahlström,S. Ekdahl,L. O. Hemmingson,L. Holmberg,B. Lernfelt,H. Nilsson B Widgren,K. Ångman,P. Erne,P. Mohacsi,R. Polikar,H. Schläpfer,P. Batin,K. E. Berkin,T. S. Callaghan,J. Forfar,Michael P. Frenneaux,R A Greenbaum,M. Maltz,D. Murdoch,G. Reynolds,J. Stephens,Allan D. Struthers,J. Swan,G. Tildesley,A. Abbasi,P. Alagona,J. Alderman,M. Alipour,J. L. Anderson,Z. Ansari,M. Ashraf,B. T. Beanblossom,S. Bennett,D. Benvenuti,Martin R. Berk,R. Bhalla,Seth Bilazarian,K. F. Browne,C. MBuchter,R. Carlson,C. J. Carlson,K. Danisa,Ira Dauber,Marcus A. Dewood,G. Dennish,D. M. Denny,R. DiBianco,P. M. Diller,Mark E. Dunlap,K. Dowd,A. Edmiston,M. El Shahawy,Uri Elkayam,J. Farnham,P. Fenster,S. Friedman,T. Heywood,J. P. Galichia,Michael R. Geller,Jalal K. Ghali,Mihai Gheorghiade,T. Giles,R. Gillespe,G. Goldberg,M. C. Goldberg,D. A. Goldscher,G. P. Gooden,M. Goodman,L. Goodman,J. Gorwit,Shmuel Gottlieb,A. Gradman,D. Grech,T. Hack,J. H. Hall,M. T. Hattenhauer,M. B. Higginbotham,S. Hutchins,M. Imburgia,B. J. Iteld,B. Jackson,S. Jafri,W. Jauch,S. Jennison,B. H. Kahn,W. Kao,K. Kaplan,Ronald P. Karlsberg,Harold L. Kennedy,J. J. Kennedy,L. Kirkegaard,D. H. Kraus,K. LaBresh,L. Lalonde,M. F. Lesser,R. Levites,M. Levy,R. K. Lewis,Irving K. Loh,H. Madyoon,F. Maislos,Douglas L. Mann,G. L. Maurice,A. Nisar,W. Old,J. D. Pappas,K. Phadke,S. Promisloff,A. M. Rashkow,B. Reeves,J. H. Rosen,M. Rotman,T. Saleem,S. V. Savran,R. Shah,Y. Shalev,J. Shanes,M. O'Shaughnessy,B. Silverman,Richard M. Steingart,L. Swenson,K. Syed,U. Thadani,R. D. Thorsen,M. J. Tonkon,R. Touchon,G. Uhl,K. J. Vaska,S. G. Wagner,C. J. Weaver,Robert J. Weiss,W. J. Wickemeyer,H. J. Willens,J. R. Wilson,R. Wright,L. Yellen +350 more