Eplerenone improves prognosis in postmyocardial infarction diabetic patients with heart failure: results from EPHESUS

O’Keefe, James H.; Abuissa, Hussam; Pitt, Bertram

doi:10.1111/j.1463-1326.2007.00730.x

Cited by 64 publications

(46 citation statements)

References 23 publications

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“…26 Aldosterone induces fibrosis in the heart, blood vessels, and kidney, 25 and the antagonism of mineralocorticoid receptors has been associated with reduced fibrosis in human myocardium, limited ventricular remodeling, and improved survival in patients with ventricular dysfunction and heart failure. 14,[25][26][27][28] Our results suggest a greater benefit in terms of survival if MRA treatment is started as early as possible. a Users who initiated mineralocorticoid receptor antagonists at discharge; b users who filled an mineralocorticoid receptor antagonists prescription 30 to 90 days after discharge; c rates of cardiac medication use up to the matched time of first mineralocorticoid receptor antagonists prescription.…”

Section: Pathophysiological Effects Of Aldosterone and "Aldosterone Ementioning

confidence: 61%

Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure

Rossi

Crupi

Coppi

et al. 2013

J Renin Angiotensin Aldosterone Syst

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Introduction: Several studies have definitively shown the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF). However, very few prior studies examined the relationship between the timing of initiation of MRAs and prognosis. In addition, on this topic, there is no information regarding the specific population of patients suffering a first episode of decompensated congestive HF. Methods: We studied a homogenous cohort of patients discharged alive from our hospital after a first episode of decompensated congestive HF, in order to clarify the association between time of aldosterone receptor antagonist (ARA) initiation (within the first 90 days after hospital discharge) and mortality. Our population was composed of a series of consecutive patients. All-cause mortality was compared between patients who initiated MRAs at discharge (early group) and those who initiated MRAs one month later and up to 90 days after discharge (delayed group). We used prescription time distribution matching to control for survival difference between groups. Results: The early and delayed groups consisted of 365 and 320 patients, respectively. During the one-year follow-up, a significant difference in mortality was demonstrated between groups. Adjusted hazard ratios (HRs) for early versus delayed initiation were 1.72 (95% confidence interval (CI) 0.96 to 2.84) at six months, and 1.93 (95% CI 1.18 to 3.14) at one year. Conclusions: Delay of MRA initiation up to 30 to 90 days after discharge implies a significant increase in mortality compared with MRA initiation at discharge, after a first episode of decompensate congestive HF.

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Section: Pathophysiological Effects Of Aldosterone and "Aldosterone Ementioning

confidence: 61%

Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure

Rossi

Crupi

Coppi

et al. 2013

J Renin Angiotensin Aldosterone Syst

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“…In these trials 32% of patients were diabetic, highlighting a potential benefit of MR antagonist use to minimise cardiovascular complications in diabetic patients in addition to anti-hyperglycaemic treatment. Subgroup analysis of EPHESUS showed the beneficial effects of eplerenone were also found in patients with diabetes (O'Keefe et al 2008). Diabetic patients treated with eplerenone had a higher rate of absolute risk reduction, compared with patients without diabetes, for both end-point of death from cardiovascular causes or hospitalization for cardiovascular events (5.1 vs. 3.5%).…”

Section: Mineralocorticoid Receptor Antagonistsmentioning

confidence: 93%

Ischemic Heart Disease, Diabetes and Mineralocorticoid Receptors

Mihailidou¹

2012

Novel Strategies in Ischemic Heart Disease

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“…The same group has also shown that MR antagonism in vivo and in vitro can lead to browning of white adipocytes demonstrated by increased UCP-1 expression (Armani et al 2014). Eplerenone Eplerenone, a more selective MR antagonist, also benefits patients with heart failure and interestingly has additional benefits in those with diabetes following myocardial infarction compared with those without diabetes (O'Keefe et al 2008). A substudy of the EMPHASIS trial examined diabetes risk, and found no difference in the incidence of type 2 diabetes in heart failure patients with or without eplerenone treatment (Preiss et al 2012).…”

Section: Spironolactone and Eplerenonementioning

confidence: 99%

Adipocytes, aldosterone and obesity-related hypertension

Cat¹,

Friederich‐Persson²,

White³

et al. 2016

Journal of Molecular Endocrinology

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Aldosterone and obesity a nguyen dinh cat and others 57:1 F7-F21 AbstractUnderstanding the mechanisms linking obesity with hypertension is important in the current obesity epidemic as it may improve therapeutic interventions. Plasma aldosterone levels are positively correlated with body mass index and weight loss in obese patients is reported to be accompanied by decreased aldosterone levels. This suggests a relationship between adipose tissue and the production/secretion of aldosterone. Aldosterone is synthesized principally by the adrenal glands, but its production may be regulated by many factors, including factors secreted by adipocytes. In addition, studies have reported local synthesis of aldosterone in extra-adrenal tissues, including adipose tissue. Experimental studies have highlighted a role for adipocyte-secreted aldosterone in the pathogenesis of obesity-related cardiovascular complications via the mineralocorticoid receptor. This review focuses on how aldosterone secretion may be influenced by adipose tissue and the importance of these mechanisms in the context of obesity-related hypertension.

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Eplerenone improves prognosis in postmyocardial infarction diabetic patients with heart failure: results from EPHESUS

Abstract: Eplerenone treatment may reduce adverse CV events in diabetic patients with LVSD and signs of CHF following AMI.

Cited by 64 publications

References 23 publications

Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure

Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure

Ischemic Heart Disease, Diabetes and Mineralocorticoid Receptors

Adipocytes, aldosterone and obesity-related hypertension

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