title: Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: integrating evidence into clinical practice.
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.
authors.affiliation: INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, France. f.zannad@chu-nancy.fr
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Wendy
authors.initials: W
authors.lastname: Gattis Stough
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Hani N
authors.initials: HN
authors.lastname: Sabbah
authors.forename: Domenic A
authors.initials: DA
authors.lastname: Sica
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000818:Animals; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004719:Endomyocardial Fibrosis / Q000209:etiology / Q000503:physiopathology; D055317:Evidence-Based Practice; D006442:Glycated Hemoglobin / Q000378:metabolism; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D006947:Hyperkalemia / Q000139:chemically induced; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000139:chemically induced; D051379:Mice; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000150:complications; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D006442:Glycated Hemoglobin; D006854:Hydrocortisone; D000451:Mineralocorticoid Receptor Antagonists