Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: Integrating evidence into clinical practice
Journal article
Zannad, Faiez, Stough, Wendy Gattis, Rossignol, Patrick, Bauersachs, Johann, McMurray, John J. V., Swedberg, Karl, Struthers, Allan D., Voors, Adriaan A., Ruilope, Luis Miguel, Bakris, George L., O'Connor, Christopher M., Gheorghiade, Mihai, Mentz, Robert J., Cohen-Solal, Alain, Maggioni, Aldo Pietro, Beygui, Farzin, Filippatos, Gerasimos S., Massy, Ziad A., Pathak, Atul, ... Pitt, Bertram. (2012). Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: Integrating evidence into clinical practice. European Heart Journal. 33(22), pp. 2782 - 2795. https://doi.org/10.1093/eurheartj/ehs257
Authors | Zannad, Faiez, Stough, Wendy Gattis, Rossignol, Patrick, Bauersachs, Johann, McMurray, John J. V., Swedberg, Karl, Struthers, Allan D., Voors, Adriaan A., Ruilope, Luis Miguel, Bakris, George L., O'Connor, Christopher M., Gheorghiade, Mihai, Mentz, Robert J., Cohen-Solal, Alain, Maggioni, Aldo Pietro, Beygui, Farzin, Filippatos, Gerasimos S., Massy, Ziad A., Pathak, Atul, Pina, Ileana L., Sabbah, Hani N., Sica, Domenic A., Tavazzi, Luigi and Pitt, Bertram |
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Abstract | 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. |
Keywords | heart failure; aldosterone antagonist spironolactone; mineralocorticoid receptors |
Year | 2012 |
Journal | European Heart Journal |
Journal citation | 33 (22), pp. 2782 - 2795 |
Publisher | Oxford University Press |
ISSN | 0195-668X |
Digital Object Identifier (DOI) | https://doi.org/10.1093/eurheartj/ehs257 |
Scopus EID | 2-s2.0-84869417804 |
Page range | 2782 - 2795 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | File Access Level Controlled |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/89210/mineralocorticoid-receptor-antagonists-for-heart-failure-with-reduced-ejection-fraction-integrating-evidence-into-clinical-practice
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