title: Effects of spironolactone on long-term mortality and morbidity in patients with heart failure and mild or no symptoms.
abstract: BACKGROUND
  The purpose of this study is to evaluate long-term effects of spironolactone, an affordable and widely used aldosterone receptor blocker, in patients with heart failure (HF) and mild or no symptoms.
  
  
  METHODS
  The study is a single-blind, placebo-controlled, blinded endpoint, randomized study. Patients with New York Heart Association (NYHA) classes I to II HF and left ventricular ejection fraction < 40% were randomized to spironolactone or placebo in addition to optimal therapy. The primary endpoint was the composite of death from any cause or cardiovascular hospitalization.
  
  
  RESULTS
  A total of 130 patients were randomized to spironolactone (n = 65) or placebo (n = 65). Patients on spironolactone had a better event-free survival for cardiovascular death or cardiovascular hospitalizations and for cardiovascular hospitalizations alone. At multivariable analysis, only spironolactone therapy, left ventricular ejection fraction and serum creatinine levels had an independent prognostic value for the combined endpoint, whereas only spironolactone therapy and serum creatinine levels had an independent prognostic value for cardiovascular hospitalizations alone.
  
  
  CONCLUSIONS
  Administration of spironolactone reduced the composite of death and cardiovascular hospitalization in patients with NYHA classes I to II HF. These results suggest that spironolactone could be beneficial when administered on top of optimal therapy among patients with HF and mild or no symptoms.
authors.affiliation: Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Giorgio
authors.initials: G
authors.lastname: Caretta
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.forename: Natalia
authors.initials: N
authors.lastname: Pezzali
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faden
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Raddino
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009017:Morbidity; D011379:Prognosis; D016037:Single-Blind Method; D013148:Spironolactone / Q000627:therapeutic use*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D003404:Creatinine