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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Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association.
Biykem Bozkurt,Andrew J.S. Coats,Hiroyuki Tsutsui,Ca Magdy Abdelhamid,Stamatis Adamopoulos,Nancy M. Albert,Stefan D. Anker,John Atherton,Michael Böhm,Javed Butler,Mark H. Drazner,G. Michael Felker,Gerasimos Filippatos,Mona Fiuzat,Gregg C. Fonarow,Juan Esteban Gomez-Mesa,Paul A. Heidenreich,Teruhiko Imamura,Ewa A. Jankowska,James L. Januzzi,Prateeti Khazanie,Koichiro Kinugawa,Carolyn S.P. Lam,Yuya Matsue,Marco Metra,Tomohito Ohtani,Massimo F Piepoli,Piotr Ponikowski,Giuseppe M.C. Rosano,Yasushi Sakata,Petar M. Seferović,Randall C. Starling,John R. Teerlink,Orly Vardeny,Kazuhiro Yamamoto,Clyde W. Yancy,Jian Zhang,Shelley Zieroth +37 more
TL;DR: In this paper, a universal definition of heart failure (HF) was proposed, with symptoms and signs caused by structural and functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion.
Journal ArticleDOI
Selective Aldosterone Blockade with Eplerenone Reduces Albuminuria in Patients with Type 2 Diabetes
Murray Epstein,Gordon H. Williams,Myron H. Weinberger,Andrew J. Lewin,Scott Krause,Robin Mukherjee,Rajiv Patni,Bruce Beckerman +7 more
TL;DR: Both eplerenone treatment groups significantly reduced albuminuria from baseline as early as week 4, whereas placebo treatment (including enalapril) did not result in any significant decreases in UACR, and systolic BP decreased significantly in all treatment groups at all time points.
Journal ArticleDOI
2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
Sana M. Al-Khatib,William G. Stevenson,Michael J. Ackerman,William J. Bryant,David J. Callans,Anne B. Curtis,Barbara J. Deal,Timm Dickfeld,Michael E. Field,Gregg C. Fonarow,Anne M. Gillis,Christopher B. Granger,Stephen C. Hammill,Mark A. Hlatky,Jose A. Joglar,G. Neal Kay,Daniel D. Matlock,Robert J. Myerburg,Richard L. Page +18 more
TL;DR: Sana M. Al-Khatib, MD, MHS, FACC, FAHA, FHRS, Chair, Writing Committee, William G. Stevenson,MD, F ACC, FA HA, F HRS, Vice Chair, writing Committee.
Journal ArticleDOI
Underrepresentation of renal disease in randomized controlled trials of cardiovascular disease
TL;DR: Major cardiovascular disease trials frequently exclude patients with renal disease and do not provide adequate information on the renal function of enrollees or the effect of interventions on patients with kidneys disease, according to two reviewers.
Journal ArticleDOI
HFSA 2006 comprehensive heart failure practice guideline
Kirkwood F. Adams,JoAnn Lindenfeld,J. Malcolm O. Arnold,David W. Baker,Denise H. Barnard,Kenneth L. Baughman,John P. Boehmer,Prakash Deedwania,Sandra B. Dunbar,Uri Elkayam,Mihai Gheorghiade,Jonathan G. Howlett,Marvin A. Konstam,Marvin W. Kronenberg,Barry M. Massie,Mandeep R. Mehra,Alan B. Miller,Debra K. Moser,J. Herbert Patterson,Richard J. Rodeheffer,Jonathan Sackner-Bernstein,Marc A. Silver,Randall C. Starling,Lynne W. Stevenson,Lynne E. Wagoner +24 more
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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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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