Peter Liu, MD
In patients with left ventricular dysfunction, do aldosterone blockers reduce mortality?
Included studies compared aldosterone blockers (spironolactone, eplerenone, or canrenoate) with placebo or active control in patients with left ventricular dysfunction, including heart failure (HF) and post–myocardial infarction (MI); were ≥ 8 weeks in duration; and reported ≥ 1 clinical outcome of interest, including all-cause mortality, hospitalization, and improvement in ejection fraction (EF). Other outcomes included adverse effects.
MEDLINE, EMBASE/Excerpta Medica, International Pharmaceutical Abstracts (all 1966 to Jun 2008); Cochrane Central Register of Controlled Trials (1950 to Sep 2007); Science Citation Index Expanded (1900 to Sep 2007); National Library of Medicine Gateway, BioMed Central, OCLC PapersFirst, trial registers, and Web sites reporting unpublished trials (all to Jun 2008); and reference lists were searched for randomized controlled trials (RCTs). Authors and manufacturers of aldosterone blockers were contacted. 19 RCTs (duration 2 to 24 mo) met the selection criteria: 15 involved patients with HF (n = 3395) and 4 involved patients after MI (n = 7412). 13 trials used spironolactone, 2 used eplerenone, 3 used canrenoate, and 1 used both spironolactone and eplerenone. 8 trials had Jadad scale scores ≥ 4 out of 5.
Meta-analysis showed that aldosterone blockers reduced mortality and hospitalizations (Table) and improved EF (12 trials, n = 1639, absolute weighted mean difference 3.4%, 95% CI 1.7 to 5.2) more than placebo or active control. In unweighted analyses, hyperkalemia (5.9% vs 3.0%), renal failure (8.9% vs 1.6%), and gynecomastia (1.6% vs 0.5%) were more common in the aldosterone groups (no statistical tests reported).
Aldosterone blockade reduces mortality in patients with left ventricular dysfunction and heart failure or post–myocardial infarction but is associated with adverse renal and electrolyte abnormalities.
Aldosterone blockers vs placebo or active control in patients with left ventricular dysfunction*
*Abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a random-effects model.
†Data provided by author.
Peter Liu. Review: Aldosterone blockade reduces mortality in patients with left ventricular dysfunction. Ann Intern Med. 2009;151:JC2–9. doi: 10.7326/0003-4819-151-4-200908180-02009
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Published: Ann Intern Med. 2009;151(4):JC2-9.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Coronary Risk Factors, Endocrine and Metabolism.
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