Neurohormones and heart failure: the importance of aldosterone.
Heart failure is a major cause of cardiovascular morbidity and mortality and its incidence is on the increase. The pathophysiology of heart failure is multi-factorial but recent studies suggest that aldosterone plays an important and independent role in its progression. Emerging evidence now suggests that aldosterone exerts renal-independent effects. It binds to its mineralocorticoid receptor to produce direct effects on the myocardium and vasculature, leading to damaging processes such as hypertrophy, necrosis, fibrosis and endothelial dysfunction, factors known to contribute to the pathophysiology of heart failure. Mineralocorticoid receptor antagonists have thus emerged as a new paradigm for the treatment of heart failure. The benefits of these agents on both morbidity and mortality when used in patients with chronic symptomatic heart failure have been demonstrated by recent trials.
Odedra
K
K
Faculty of Medicine and Cardiovascular Division, GKT School of Medicine, King's College London, London, UK.
Ferro
A
A
D000222:Adaptation, Physiological; D000450:Aldosterone / Q000378:metabolism / Q000502:physiology*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D006332:Cardiomegaly / Q000209:etiology; D009202:Cardiomyopathies / Q000209:etiology; D004730:Endothelium, Vascular / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009336:Necrosis / Q000209:etiology; D018377:Neurotransmitter Agents / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D014655:Vascular Resistance / Q000502:physiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D018377:Neurotransmitter Agents; D000450:Aldosterone