TY - JOUR
T1 - Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction
T2 - Integrating evidence into clinical practice
AU - Zannad, Faiez
AU - Gattis Stough, Wendy
AU - Rossignol, Patrick
AU - Bauersachs, Johann
AU - McMurray, John J.V.
AU - Swedberg, Karl
AU - Struthers, Allan D.
AU - Voors, Adriaan A.
AU - Ruilope, Luis M.
AU - Bakris, George L.
AU - O'Connor, Christopher M.
AU - Gheorghiade, Mihai
AU - Mentz, Robert J.
AU - Cohen-Solal, Alain
AU - Maggioni, Aldo P.
AU - Beygui, Farzin
AU - Filippatos, Gerasimos S.
AU - Massy, Ziad A.
AU - Pathak, Atul
AU - Piña, Ileana L.
AU - Sabbah, Hani N.
AU - Sica, Domenic A.
AU - Tavazzi, Luigi
AU - Pitt, Bertram
N1 - Funding Information:
This work was generated from discussions during the Eighth Global Cardiovascular Clinical Trialists (CVCT) Forum held in Paris, France, in December 2011. CVCT was organized by the Clinical Investigation Center (CIC) Inserm, CHU, and University Henri Poincaréof Nancy, France and funded by an unrestricted educational grant from Association de Recherche et d’Information en Cardiologie (ARISC) a non-profit educational organisation, in Nancy, France. ARISC had no involvement in preparation, review, or approval of the manuscript for publication.
PY - 2012/11
Y1 - 2012/11
N2 - Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HF-REF), 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 HF-REF.
AB - Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HF-REF), 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 HF-REF.
KW - Aldosterone antagonist spironolactone
KW - Heart failure
KW - Mineralocorticoid receptors
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U2 - 10.1093/eurheartj/ehs257
DO - 10.1093/eurheartj/ehs257
M3 - Review article
C2 - 22942339
AN - SCOPUS:84869417804
SN - 0195-668X
VL - 33
SP - 2782
EP - 2795
JO - European heart journal
JF - European heart journal
IS - 22
ER -