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
Aldosterone and mineralocorticoid receptors: Clinical studies and basic biology.
TL;DR: This review sets out to chart how three sets of clinical observations, in hypertension and heart failure, have triggered a radical re-evaluation (and expansion) of the authors' previous concepts of the basic (patho)physiology of aldosterone and mineralocorticoid receptors (MR).
Journal ArticleDOI
Effects of aldosterone receptor blockade in patients with mild-moderate heart failure taking a beta-blocker
Colin Berry,Niamh F. Murphy,Giuseppe De Vito,Stuart D.R. Galloway,Alison Seed,Carol Fisher,Naveed Sattar,P Vallance,W. Sewart Hillis,John J.V. McMurray +9 more
TL;DR: In this paper, spironolactone (25 mg daily) was shown to improve prognosis in severe heart failure (HF) patients with ACE inhibitor and beta-blocker.
Journal ArticleDOI
The Aldosterone Synthase (CYP11B2) and 11β-Hydroxylase (CYP11B1) Genes Are Not Expressed in the Rat Heart
P Ye,Christopher J. Kenyon,Scott M. MacKenzie,A. S. Jong,C. Miller,Gillian A. Gray,A. Wallace,A. S. Ryding,John J. Mullins,M. W. McBride,Delyth Graham,Robert Fraser,J. M. C. Connell,Eleanor Davies +13 more
TL;DR: Cardiac CYP11B1 and CYP 11B2 mRNA transcript levels from all in vivo and in vitro groups were never greater than 100 copies per microgram total RNA and therefore too low to be detected reproducibly, suggesting that cardiac corticosteroid production is unlikely to be of any physiological or pathological significance.
Journal ArticleDOI
Mineralocorticoid receptors: emerging complexity and functional diversity.
Alex Odermatt,Atanas G. Atanasov +1 more
TL;DR: This review addresses the emerging new view of the complex mechanisms underlying MR specificity of action, with a diversity of physiological roles and functions in different mineralocorticoid-responsive tissues.
Journal ArticleDOI
Sistema endocrino y corazon: una revision
Soo S. Rhee,Elizabeth N. Pearce +1 more
TL;DR: The epidemiology, diagnosis, and management of disorders of the pituitary, thyroid, parathyroid, and adrenal glands, with respect to the impact of endocrine dysfunction on the cardiovascular system are discussed.
References
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The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.
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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
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