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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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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Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology
Stefano Bianchi,Filippo Aucella,Luca De Nicola,Simonetta Genovesi,Ernesto Paoletti,Giuseppe Regolisti +5 more
TL;DR: This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.
Journal ArticleDOI
Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America.
Shannon M. Dunlay,Michael M. Givertz,David Aguilar,Larry A. Allen,Michael Chan,Akshay S. Desai,Anita Deswal,Victoria Vaughan Dickson,Mikhail Kosiborod,Carolyn L. Lekavich,Rozalina G. McCoy,Robert J. Mentz,Ileana L. Piña +12 more
TL;DR: The approach to pharmacological therapy and lifestyle modification in patients with diabetes mellitus and heart failure is reviewed; the value of multidisciplinary interventions to improve clinical outcomes in this population is highlighted; and priorities for future research are outlined.
Journal ArticleDOI
Primary aldosteronism: current knowledge and controversies in Conn's syndrome
TL;DR: Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass, which requires additional work up to prove mineralocorticoid excess.
Journal ArticleDOI
2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Marco Roffi,Carlo Patrono,Jean-Philippe Collet,Christian Mueller,Marco Valgimigli,Felicita Andreotti,Jeroen J. Bax,Michael A. Borger,Carlos Brotons,Derek P. Chew,Baris Gencer,Gerd Hasenfuss,Keld Kjeldsen,Patrizio Lancellotti,Ulf Landmesser,Julinda Mehilli,Debabrata Mukherjee,Robert F. Storey,Stephan Windecker +18 more
TL;DR: The comparison of prasugrel at the time of Percutaneous Coronary Intervention or as Pretreatment at the Time of Diagnosis in Patients with Non-ST Elevation Myocardial Infarction was conducted by.
Journal ArticleDOI
Conditional glucocorticoid receptor expression in the heart induces atrio-ventricular block
Yannis Sainte-Marie,Yannis Sainte-Marie,Aurelie Nguyen Dinh Cat,Aurelie Nguyen Dinh Cat,Romain Perrier,Romain Perrier,Laurence Mangin,Laurence Mangin,Christelle Soukaseum,Christelle Soukaseum,Michel Peuchmaur,François Tronche,Nicolette Farman,Nicolette Farman,Brigitte Escoubet,Jean-Pierre Benitah,Jean-Pierre Benitah,Frederic Jaisser,Frederic Jaisser +18 more
TL;DR: Conditional glucocorticoid receptor expression in the heart induces atrio‐ventricular block, indicating that GR has direct and specific cardiac effects in the mouse.
References
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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).
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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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