Drug may improve outcomes after heart attack

March 12, 2013, American College of Cardiology

The prescription drug eplerenone appears to reduce the risk of cardiovascular mortality and heart failure after a heart attack by more than one-third, according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session.

The REMINDER (Reduction of heart failure morbidity in with acute ST-elevation ) trial was a randomized, double-blind trial of 1,012 patients who had a caused by a complete blockage of one of the heart's arteries. Patients had no signs or history of heart failure. They were given either eplerenone or placebo in addition to standard therapy. Overall, patients taking eplerenone were 38 percent less likely to have poor outcomes than those given a placebo.

Eplerenone counteracts a hormone called aldosterone, which can increase blood pressure. The drug is currently approved to treat hypertension and as a treatment for patients who have heart failure several days after a heart attack.

"This is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a ," said Gilles Montalescot, MD, PhD, lead investigator of the study and professor of cardiology and head of the Cardiac Care Unit at Pitié-Salpétrière Hospital, Paris.

About 5.8 million Americans have heart failure, a condition in which the heart cannot pump enough blood to meet the body's oxygen and energy needs. Improvements in heart attack treatment have increased chances of survival, but damage after heart attack is one risk factor for heart failure. Clinical trials and registries show that in the 30 days after a first heart attack, between 8.6 percent and 40 percent of patients will be diagnosed with heart failure.

The primary endpoint of the REMINDER trial included several outcomes:

  • Rehospitalization or extended initial hospital stay due to heart failure
  • Severe rhythm disruptions of the heart (arrhythmias)
  • Ejection fraction of 40 percent or lower after one month, which can indicate heart failure
  • An elevation of brain natriuretic peptide (BNP) and its associated protein, NT-proBNP, after one month, which can indicate heart failure
Patients who had one of these outcomes were considered to have reached the primary endpoint. After a mean follow-up of 10.5 months, patients on eplerenone had one of these outcomes less often than those receiving placebo (18.4 vs. 29.6 percent, p<0.0001). Also, only 16 percent of patients on eplerenone had an elevation of BNP/NT-proBNP after one month, compared with 25.9 percent receiving placebo (p<0.0002). Adverse events rates were similar in both groups.

"Eplerenone has the potential to reduce clinical and subclinical failure in STEMI patients," Dr. Montalescot said.

The study population was low-risk (the mortality rate was 0.4 percent) and was receiving standard treatment.

"Despite this, a benefit was observed with eplerenone to prevent adverse outcomes and subclinical ," Dr. Montalescot said. "Confirmation in a higher-risk population with a longer follow-up would be important to support this new strategy."

The ongoing ALBATROSS [Aldosterone Blockade Early After Acute Myocardial Infarction] study is investigating this hypothesis, Dr. Montalescot added.

Explore further: EMPHASIS HF: Study shows epleronone to reduce atrial fibrillation

Related Stories

EMPHASIS HF: Study shows epleronone to reduce atrial fibrillation

May 22, 2011
The aldosterone antagonist eplerenone (Inspra, Pfizer) significantly reduced the development of new onset atrial fibrillation and flutter (AFF) in patients with class 2 heart failure, concludes a sub-analysis of the EMPHASIS-HF ...

The effect of eplerenone vs. placebo on cardiovascular mortality

August 29, 2011
Today results from a new sub-analysis of the EMPHASIS-HF study showed significant reductions in death and hospitalization for five pre-defined high-risk patient sub-groups with chronic heart failure (CHF) and mild symptoms ...

Yale researchers enroll first patient in study of heart-preserving molecule

July 24, 2012
(Medical Xpress) -- A 69-year-old man became the first patient enrolled and treated in an ongoing study at Yale School of Medicine of BB3, a molecule that promises to preserve heart muscle, promote healing and improve clinical ...

New data from studies bolsters case for using aldosterone antagonists in heart failure

September 19, 2011
Roughly 5 million people in the United States live with heart failure, a condition in which the heart is unable to pump blood around the body effectively. The causes and types of heart failure vary greatly, and treatment ...

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.