Journal
EUROPEAN HEART JOURNAL
Volume 33, Issue 22, Pages 2782-U18Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehs257
Keywords
Heart failure; Aldosterone antagonist spironolactone; Mineralocorticoid receptors
Categories
Funding
- Association de Recherche et d'Information en Cardiologie (ARISC), in Nancy, France
- Pfizer
- Pfizer regarding eplerenone
- Forest Labs
- Amgen
- Novartis
- Bayer
- Roche
- Servier
- Sanofi-Aventis
- Astellas
- BRAHMS
- Federation Francaise de Cardiologie
- Bayer Healthcare AG
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Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HFREF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These clinical benefits are observed in addition to those of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers. The morbidity and mortality benefits of MRAs may be mediated by several proposed actions, including antifibrotic mechanisms that slow heart failure progression, prevent or reverse cardiac remodelling, or reduce arrhythmogenesis. Both eplerenone and spironolactone have demonstrated survival benefits in individual clinical trials. Pharmacologic differences exist between the drugs, which may be relevant for therapeutic decision making in individual patients. Although serious hyperkalaemia events were reported in the major MRA clinical trials, these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up. When used appropriately, MRAs significantly improve outcomes across the spectrum of patients with HFREF.
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