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Published on: June 28, 2019
Vascular Effects of Eplerenone in Coronary Artery Disease With Preserved Ejection Fraction: A Double-Blind,
Isabella Sudano1, Matthias Naegele1, Susanne Roas1
1University Heart Center, Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
Insights
Mineralocorticoid receptor antagonists (MRAs) did not improve vascular health markers in coronary artery disease (CAD) patients with preserved ejection fraction (EF). This study suggests eplerenone offers no benefit for these specific vascular health indicators in CAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Mineralocorticoid receptor antagonists (MRAs) are established treatments for heart failure with reduced ejection fraction (HFrEF), improving morbidity and mortality.
- The efficacy of MRAs in patients with coronary artery disease (CAD) and preserved ejection fraction (EF) remains unclear and is a subject of ongoing research.
Purpose of the Study:
- To investigate the effect of the MRA eplerenone on endothelial function and vascular health markers in patients with CAD and preserved EF.
- To evaluate if eplerenone, in addition to standard therapy, can improve endothelial dysfunction in this patient population.
Main Methods:
- A double-blind, randomized, placebo-controlled study involving 42 patients with CAD and preserved EF.
- Participants received either 4 weeks of eplerenone (25 mg daily) or a placebo.
- Primary endpoint was flow-mediated dilatation (FMD); secondary endpoints included 24-hour blood pressure, endothelial progenitor cells, and platelet adhesion.
Main Results:
- No significant difference in FMD was observed between the eplerenone and placebo groups (4.7% ± 2.0% vs. 4.9% ± 2.1%, P = 0.77).
- Eplerenone did not significantly alter 24-hour blood pressure, endothelial progenitor cell counts, or platelet adhesion compared to placebo.
Conclusions:
- Adding low-dose eplerenone to standard medical therapy did not improve key vascular health markers in patients with CAD and preserved EF.
- These findings contribute to understanding the conflicting evidence regarding MRA use in patients with preserved EF.
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.
Hypothesis:
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.
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