Myocardial infarction eplerenone

Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Trial... 

It has also been found that low doses of eplerenone (25-50 mg/d) may interfere with some of the fibrotic and inflammatory effects of aldosterone. By doing so, it can reduce the progression of albuminuria in diabetic patients. More important is that eplerenone has been found to reduce myocardial perfusion defects after myocardial infarction. In one clinical study, eplerenone reduced mortality rate by 15% (compared with placebo) in patients with mild to moderate heart failure after myocardial infarction. 

BMJ group Eplerenone after myocardial infarction Drug Ther Bull 2008 46(1) 1. 

Abbreviations ACE, angiotensin-converting enzyme AMI, acute myocardial infarction EPHESUS, eplerenone postacute myocardial infarction heart failure efficacy and survival study HF, heart failure LVEF, left ventricular ejection fraction NYHA. New York Heart Association RALES, randomized aldactone evaluation study. 

Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003 348 1309-1321. 

In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), in 6632 patients with an acute myocardial infarction complicated by left ventricular dysfunction and heart failure, the addition of eplerenone 25-50 mg/day to optimal medical therapy significantly reduced all-cause mortality by 15% and cardiovascular mortality by 17% over a mean follow-up period of 16 months hospitalization rates were also reduced (29). 

Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M, Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003 348(14) 1309-21. 

The addition of aldosterone antagonists can rednce morbidity and mortality in systolic heart failure. Spironolactone has been studied in severe heart failure and has shown benefit in addition to diuretic and ACE inhibitor therapy. Eplerenone, the newest aldosterone antagonist, has been smdied in patients with symptomatic systolic heart failure within 3 to 14 days after an acute myocardial infarction in addition to a standard three-drug regimen. Collectively, both these agents should be considered in the specific heart failure population smdied but only in addition to diuretics, ACE/ARBs, and /8-blockers. 

Eplerenone has been shown recently to reduce morbidity and mortality in patients soon after experiencing an acute myocardial infarction (within 3 to 14 days). However, this supporting evidence was in patients with symptoms of acute left ventricular dysfunction (systolic heart failure). Considering that this drug has a propensity to cause significant hyperkalemia, and given the patient population studied, eplerenone should be used only in selected patients following a myocardial infarction. 

Clinical experience with eplerenone is limited. Nonetheless, eplerenone appears to be a safe and effective antihypertensive drug. In patients with acute myocardial infarction complicated by left ventricular systolic dysfunction, addition of eplerenone to optimal medical therapy significantly reduces morbidity and mortality. 

Cardiovascular System In a prospective study assessing the eplerenone (50 mg per day) effect on 117 patients with uncontrolled HTN on at least two anti-HTN drugs showed wi drawal of four patients from the study due to cardiovascular adverse events (like myocardial infarction, two patients hypertensive urgency, one patient orthostatic hypotension, one patient). The authors suspected these may be unrelated to the use of eplerenone [44]. 

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