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
PY - 2012
Y1 - 2012
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.
U2 - 10.1093/eurheartj/ehs257
DO - 10.1093/eurheartj/ehs257
M3 - Article
C2 - 22942339
SN - 1522-9645
VL - 33
SP - 2782
EP - 2795
JO - European Heart Journal
JF - European Heart Journal
IS - 22
ER -