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 at the American College of Cardiology‘s 62nd Annual Scientific Session.
The REMINDER (Reduction of heart failure morbidity in patients with acute ST-elevation myocardial infarction) trial was a randomized, double-blind trial of 1,012 patients who had a heart attack 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% less likely to have poor outcomes than those given a placebo.
Eplerenone counteracts a hormone called aldosterone, which can increase blood pressure.
“This is the first randomized trial to test a mineralocorticoid receptor agonist during the acute phase of heart attack, and the results suggest a clinical benefit,” said Gilles Montalescot, MD, PhD, lead investigator of the study and professor of cardiology and head of the Cardiac Care Unit at Piti–Salp-tri-re Hospital, Paris.
Eplerenone / Inspra approved for Heart Failure in Scotland
Patients with chronic heart failure are to be offered a new drug which reduces their risk of being hospitalised by almost 40%.
The Scottish Medicines Consortium has approved a new drug, Inspra, for use in adults with the illness after evidence showed it reduced the risk of hospitalisation and death.
Around one in 100 people in Scotland has chronic heart failure. The new drug, also known as Eplerenone, was found to reduce the risk of cardiovascular death or heart failure hospitalisation by 37%.
John McMurray, Professor of Medical Cardiology at Glasgow University, said: “We must continue to do what we can to reduce deaths from cardiovascular disease and, importantly, do what we can to reduce the daily impact of the disease on those patients with established illness through optimal management.
“By ensuring patients receive the most effective treatments we can keep them out of hospital which is great for patients and can also help relieve the pressure on healthcare budgets.”
Heart failure occurs when the efficiency of the heart is impaired, resulting in it becoming unable to pump a sufficient amount of blood to meet the demands of the body.
Common causes of heart failure include damage to the heart caused by a heart attack, ischaemic heart disease and high blood pressure.
Is there another way of treating Heart Failure?
People with mild or moderate heart failure got good news yesterday: Studies show a Pfizer drug and a device from Medtronic can boost survival rates and cut trips to the hospital by those who have trouble breathing. But another drug, Johnson & Johnson’s Natrecor, did little to help those with severe heart failure. “It’s hard to tell now which patients should get the pricey medicine, said Dr. Alfred Bove, past president of the American College of Cardiology. All three studies, presented at an American Heart Association conference, are expected to have an immediate effect on care.
Inspra, made by Pfizer is already used for advanced heart failure. In a study of more than 2,700 people with milder symptoms, it cut the risk of death or hospitalization by 37 percent. After nearly two years, fewer than 13 percent of those on Inspra had died of heart problems, versus fewer than 16 percent of those given dummy pills.
“This has the potential of changing the guidelines,’’ said Dr. Mariell Jessup, who heads the heart failure program at the University of Pennsylvania.
Many doctors saw an alternative: wider use of an older relative of Inspra, spironolactone, a generic medicine that costs less than 20 cents a day, versus about $133 a month for Inspra.
The other good news came from a test of an implanted heart device made by Medtronic Inc. Many people with severe heart failure have defibrillators to zap their hearts if they suffer a rhythm problem. Newer combination devices also control how blood moves through the heart. Defibrillators cost $20,000 to $25,000; the combinations are $5,000 to $7,000 more.
The study tested them in 1,800 Canadian patients with mild to moderate heart failure. More than three years later, 40 percent of those with simple defibrillators had died or been hospitalized for heart failure, versus 33 percent of those with combo devices.
The bad news came from a test of Natrecor for shortness of breath. One of six people hospitalized with heart failure were given Natrecor until 2005, when studies suggested it raised the risk of kidney problems. In tests involving more than 7,000 patients, Natrecor, made by Scios Inc., made no difference in rates of hospitalization or death in the following month and only modestly relieved shortness of breath within 6 hours of its infusion.