A recently released drug can save the lives of certain patients recovering from a heart attack, according to a prominent study that drew on the success of the USC Heart Failure Program.
Eplerenone, known by the trade name Inspra, was approved for the treatment of hypertension in September 2002. It belongs to the class of drugs known as selective aldosterone receptor antagonists, and physicians may also use it to treat heart failure.
Researchers have known that the drug helps reduce the death rate and hospitalizations due to heart failure among patients with systolic left ventricular dysfunction (problems with pumping blood out of the left ventricle) who are taking an angiotensin-converting-enzyme, or ACE, inhibitor. But blocking aldosterone also seems to help the hearts of patients with left ventricular dysfunction after a heart attack. It also affects several mechanisms that are important in patients’ outcomes after a heart attack, so researchers decided to put eplerenone to the test in these patients.
Physician-researchers across Europe, Latin America, Canada and the United States randomly assigned patients to receive either standard medical therapy and eplerenone or the standard therapy and a placebo. They enrolled 6,632 patients in the study, signing up patients until they had 1,012 deaths. With an average follow-up of 16 months, 478 patients in the eplerenone group and 554 patients in the placebo group died.
Patients taking eplerenone were 17 percent less likely than those in the other group to die from a cardiovascular cause. They also were 21 percent less likely to die a sudden death from cardiac causes.
The researchers found that more of the patients taking eplerenone experienced hyperkalemia, too much potassium in the body, which needs to be monitored carefully. At the same time eplerenone prevented episodes of hypokalemia, too little potassium, which can be life-threatening, he added.
Physicians concluded that for every 50 patients with left ventricular dysfunction recovering from a heart attack who take eplerenone, one life will be saved; for every 33 such patients taking eplerenone, one will avoid death from cardiovascular causes or a hospitalization for cardiovascular causes for a year.
The company Pharmacia, which makes eplerenone, supported the research.
Bertram Pitt, Willem Remme and Faiez Zannad, et al., “Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction,” The New England Journal of Medicine. Vol. 348, No. 14, pp. 1309-1321.