title: Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects.
  
  
  METHODS
  We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia).
  
  
  RESULTS
  Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67-0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74-0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70-0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66-0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76-0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74-0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71-0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77-0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74-0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased.
  
  
  CONCLUSIONS
  Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Hai-Ha
authors.initials: HH
authors.lastname: Le
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Chadia
authors.initials: C
authors.lastname: El-Khatib
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Margaux
authors.initials: M
authors.lastname: Mombled
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guitarian
authors.affiliation: Lausanne University Hospital (CHUV), Institute of social & preventive medicine (IUMSP), Lausanne, Switzerland.
authors.forename: Muaamar
authors.initials: M
authors.lastname: Al-Gobari
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Mor
authors.initials: M
authors.lastname: Fall
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Perrine
authors.initials: P
authors.lastname: Janiaud
authors.affiliation: Escuela de Medicina, Departamento de Pre-clínicas, Universidad de Valparaíso, Valparaíso, Chile.
authors.forename: Ivanny
authors.initials: I
authors.lastname: Marchant
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Cucherat
authors.affiliation: CHRU de Tours, Service de Pharmacologie Clinique, Hôpital Bretonneau, Tours, France.|CNRS UMR 7292, Tours, France.|Université François-Rabelais, GICC, Tours, France.
authors.forename: Théodora
authors.initials: T
authors.lastname: Bejan-Angoulvant
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France.|Service de Pharmacologie Clinique et essais thérapeutiques, Hospices Civils de Lyon, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Gueyffier
mesh_terms: D016757:Death, Sudden, Cardiac / Q000473:pathology / Q000517:prevention & control*; D006177:Gynecomastia / Q000209:etiology / Q000473:pathology; D006333:Heart Failure / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000473:pathology; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D016017:Odds Ratio; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000209:etiology / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists