Περίληψη:
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.
Συγγραφείς:
Zannad, Faiez
Stough, Wendy Gattis
Rossignol, Patrick and
Bauersachs, Johann
McMurray, John J. V.
Swedberg, Karl and
Struthers, Allan D.
Voors, Adriaan A.
Ruilope, Luis M. and
Bakris, George L.
O'Connor, Christopher M.
Gheorghiade, Mihai
and Mentz, Robert J.
Cohen-Solal, Alain
Maggioni, Aldo P. and
Beygui, Farzin
Filippatos, Gerasimos S.
Massy, Ziad A. and
Pathak, Atul
Pina, Ileana L.
Sabbah, Hani N.
Sica, Domenic
A.
Tavazzi, Luigi
Pitt, Bertram
