Eplerenone cuts death and hospitalization rates among patients fighting less severe but chronic forms of the condition
CHICAGO — People with mild heart failure symptoms may benefit from a drug previously reserved for patients with more severe forms of the condition or high blood pressure. The drug, called eplerenone, reduces the risk of hospitalization and death in patients with a milder, chronic form of heart failure, a new study finds. Physician Faiez Zannad of the Nancy University Hospital Center in Nancy, France, presented the findings November 14 at a meeting of the American Heart Association.
Zannad and his colleagues randomly assigned 2,737 patients, average age 69, to get either eplerenone or a placebo. After the groups had been followed for 21 months on average, the trial was stopped when it became clear the drug benefited those taking it. During follow-up 26 percent of people getting the placebo were hospitalized for heart failure or died from cardiovascular causes compared with only 18 percent of those getting the drug.
Heart failure occurs when the heart struggles to serve the needs of the body. These study participants had systolic heart failure, in which the force of blood flow from the heart was impaired, leaving them short of breath and easily fatigued from exercise.
Eplerenone, an oral drug marketed as Inspra, lessens blood volume. It offsets the action of a hormone called aldosterone that increases blood pressure. Zannad said the new findings should extend the use of eplerenone to people with mild, chronic heart failure. “This provides compelling evidence to change medical practice,” he said. The findings were also published online November 14 in the New England Journal of Medicine.
“This is an exciting day indeed, when we can talk about a new patient population for this drug,” said physician Mariell Jessup of the University of Pennsylvania in Philadelphia.
F. Zannad et al. The effect of eplerenone versus placebo on cardiovascular mortality or heart failure hospitalization in subjects with NYHA Class II chronic systolic heart failure (EMPHASIS HF). Abstract 23221, American Heart Association annual meeting, Chicago, November 13-17, 2010.
F. Zannad et al. Eplerenone inpatients with systolic heart failure and mild symptoms. New England Journal of Medicine, 2010, in press.
B. Pitt et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine, Vol. 348, 2003, p. 1309.
B. Pitt et al. Efficacy and safety of eplerenone, enalapril, and eplerenone/enalapril combination therapy in patients with left ventricular hypertrophy. American Journal of Hypertension, Vol. 15, p. 23A. 2002.