PMID: 15218387Jun 26, 2004Paper

Aldosterone antagonism and congestive heart failure: a new look at an old therapy

Current Opinion in Cardiology
Vinay ThohanMicheal M Koerner

Abstract

More than 5 million people in the United States alone have congestive heart failure, and an estimated 40 million have established risks and warrant therapy. Mineralocorticoid antagonists have emerged as a new paradigm for the treatment of congestive heart failure. They have established benefits among patients with chronic symptomatic systolic dysfunction, and recent studies have demonstrated substantial effect on the morbidity and mortality among patients with heart failure after myocardial infarction. The exact biologic mechanism is thus far unknown. Within the last 5 years, efforts have intensified to help define better the biologic mechanisms by which mineralocorticoid receptor antagonisms exert the observed clinical benefit. Elegant human studies have demonstrated some important observations. First, under conditions of increased plasma aldosterone concentrations, the heart will extract aldosterone. Second, aldosterone extraction in the heart stimulates increased collagen turnover culminating in ventricular remodeling. Third, among people with chronic systolic or diastolic heart failure, aldosterone is actually produced and secreted by the heart. Finally, antagonism of the mineralocorticoid receptor will attenuate or abrogat...Continue Reading

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Citations

Mar 23, 2005·Current Opinion in Pharmacology·Burton E Sobel, David J Schneider
Sep 24, 2005·International Journal of Clinical Practice·E B Wu, C M Yu
Jul 11, 2008·Journal of Clinical Pharmacy and Therapeutics·R MariottiL Rondinini
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Nov 5, 2008·AACN Advanced Critical Care·Christopher S Lee, Nancy C Tkacs

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