title: Vascular Effects of Eplerenone in Coronary Artery Disease With Preserved Ejection Fraction: A Double-Blind, Randomized, Placebo-Controlled Trial.
abstract: BACKGROUND
  Mineralocorticoid receptor antagonists (MRAs) reduce morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). Their role in patients without heart failure, particularly in patients with coronary artery disease (CAD) and preserved EF, is still a matter of debate.
  
  
  OBJECTIVE
  The MRA eplerenone on top of standard medical therapy improves endothelial dysfunction and other markers of vascular health in CAD patients with preserved EF.
  
  
  METHODS
  In this double-blind, randomized, placebo-controlled study, 42 patients (mean age: 63.5 ± 9.1 years; 37 males) were randomized to 4-week treatment with eplerenone 25 mg daily or placebo. The primary endpoint was difference in endothelial function as assessed by flow-mediated dilatation (FMD) of the brachial artery. Secondary endpoints included 24-hour blood pressure (BP), endothelial progenitor cells, and platelet adhesion.
  
  
  RESULTS
  No difference in the primary endpoint FMD was noted after 4 weeks of treatment with eplerenone compared with placebo (FMD: 4.7% ± 2.0% and 4.9% ± 2.1%, respectively; P = 0.77). There were no significant differences between eplerenone and placebo in 24-hour BP (mean systolic BP: 126.9 ± 17.3 and 123.3 ± 9.7 mm Hg, P = 0.41; diastolic BP: 73.3 ± 12.9 and 72.0 ± 7.5 mm Hg, respectively, P = 0.69), number of endothelial progenitor cells, and platelet adhesion.
  
  
  CONCLUSIONS
  Adding low-dose eplerenone to standard medical therapy did not improve important markers of vascular health in patients with CAD and preserved EF. Our results may help understand conflicting evidence from larger clinical trials on MRAs in patients with preserved EF.
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sudano
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Naegele
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Roas
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Périat
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michelle
authors.initials: M
authors.lastname: Frank
authors.affiliation: Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Alexey
authors.initials: A
authors.lastname: Kouroedov
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.|Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Noll
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.|Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.|Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Flammer
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001916:Brachial Artery / Q000187:drug effects* / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D066026:Endothelial Progenitor Cells / Q000187:drug effects; D000077545:Eplerenone; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D010973:Platelet Adhesiveness / Q000187:drug effects; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013318:Stroke Volume; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects; D016277:Ventricular Function, Left
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone