Spironolactone in Patients With Heart Failure, Preserved Ejection Fraction, and Worsening Renal Function
| Autor: | Sonja M. McKinlay, Orly Vardeny, James C. Fang, Marc A. Pfeffer, Bertram Pitt, Michael R. Bristow, Akshay S. Desai, Eileen O'Meara, Iris E. Beldhuis, Kevin Damman, Scott D. Solomon, Sanjiv J. Shah, Peder L. Myhre, Eldrin F. Lewis, Brian Claggett, Jerome L. Fleg, Adriaan A. Voors |
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| Přispěvatelé: | Cardiovascular Centre (CVC) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
heart failure with preserved ejection fraction medicine.medical_specialty 030204 cardiovascular system & hematology Lower risk Placebo Kidney 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Double-Blind Method Internal medicine Medicine Humans 030212 general & internal medicine Aged Mineralocorticoid Receptor Antagonists Aged 80 and over Heart Failure Ejection fraction business.industry Proportional hazards model Stroke Volume Odds ratio Middle Aged medicine.disease spironolactone chemistry Heart failure worsening renal function Cardiology Spironolactone Female Kidney Diseases Cardiology and Cardiovascular Medicine business Heart failure with preserved ejection fraction Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | Journal of the American College of Cardiology, 77(9), 1211-1221. ELSEVIER SCIENCE INC |
| ISSN: | 0735-1097 |
| Popis: | BACKGROUND Treatment of heart failure with preserved ejection fraction (HFpEF) with spironolactone is associated with lower risk of heart failure hospitalization (HFH) but increased risk of worsening renal function (WRF). The prognostic implications of spironolactone-associated WRF in HFpEF patients are not well understood.OBJECTIVES The purpose of this study was to investigate the association between WRF, spironolactone treatment, and clinical outcomes in patients with HFpEF.METHODS In 1,767 patients randomized to spironolactone or placebo in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial)-Americas study, we examined the incidence of WRF (doubling of serum creatinine) by treatment assignment. Associations between incident WRF and subsequent risk for the primary study endpoint of cardiovascular (CV) death, HFH, or aborted cardiac arrest and key secondary outcomes, including CV death, HFH, and all-cause mortality according to treatment assignment, were examined in time-updated Cox proportional hazards models with an interaction term.RESULTS WRF developed in 260 (14.7%) patients with higher rates in those assigned to spironolactone compared to placebo (17.8% vs. 11.6%; odds ratio: 1.66; 95% confidence interval: 1.27 to 2.17; p < 0.001). Regardless of treatment, incident WRF was associated with increased risk for the primary endpoint (hazard ratio: 2.04; 95% confidence interval: 1.52 to 2.72; p < 0.001) after multivariable adjustment. Although there was no statistical interaction between treatment assignment and WRF regarding the primary endpoint (interaction p = 0.11), spironolactone-associated WRF was associated with lower risk of CV death (interaction p = 0.003) and all-cause mortality (interaction p = 0.001) compared with placebo-associated WRF.CONCLUSIONS Among HFpEF patients enrolled in TOPCAT-Americas, spironolactone increased risk of WRF compared with placebo. Rates of CV death were lower with spironolactone in both patients with and without WRF. (c) 2021 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved. |
| Databáze: | OpenAIRE |
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