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Trinchieri A, Perletti G, Magri V, Stamatiou K, Trinchieri M, Montanari E. Drug-induced gynecomastia: A systematic review and meta-analysis of randomized clinical trials. Arch Ital Urol Androl 2021; 93:489-496. [PMID: 34933535 DOI: 10.4081/aiua.2021.4.489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To review the evidence concerning treatment-related gynecomastia in patients taking spironolactone, antiandrogens, 5 alpha-reductase inhibitors, lipid-lowering and psychotropic drugs. MATERIAL AND METHODS A search of Medline and EMBASE was performed up to 30 June 2021. We included randomized controlled trials comparing the effects of a drug belonging to these classes versus placebo or versus a drug of the same class. RESULTS A total of 32 randomized controlled trials were included in the final review. There was an increased odds of gynecomastia in men receiving antiandrogens (OR = 17.38, 95% CI: 11.26 to 26.82; 6 trials, 9599 participants) and 5 alpha-reductase inhibitors compared to controls (OR = 1.77, 95% CI: 1.53 to 2.06; 7 series out of 6 trials, 34860 participants). The use of spironolactone in mixed gender populations was characterized by significantly higher odds of having gynecomastia compared to controls (OR = 8.39, 95% CI: 5.03 to 13.99; 14 trials, 3745 participants). No placebo-controlled trials focusing on the risk of gynecomastia in patients taking antipsychotic drugs was available, although there was a significant difference in the odds of having gynecomastia in a comparison between risperidone and quetiapine (OR = 4.32, 95% CI: 1.31 to 14.27; 3 trials, 343 participants). Limited evidence about the effects of statins on mammary glands was found. CONCLUSIONS Antiandrogens and to a lesser extent 5 alphareductase inhibitors and spironolactone are associated with an increased risk of developing gynecomastia. Such effect can be explained by a modification of the testosterone to estradiol ratio. Gynecomastia (and galactorrhea) associated to the use of conventional and certain atypical antipsychotics can be related to high prolactin levels.
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Affiliation(s)
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy; Faculty of Medicine and Medical Sciences, Ghent University.
| | | | | | | | - Emanuele Montanari
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan.
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Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Cardiovasc Ther 2021; 2021:1710731. [PMID: 34786023 PMCID: PMC8560277 DOI: 10.1155/2021/1710731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. Results 15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P = 0.002) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P < 0.00001) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P < 0.0001). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P = 0.007) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P = 0.002). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P < 0.00001), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P = 0.02), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P = 0.05). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P < 0.00001) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Conclusions Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.
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Qu X, Yao H, Chen C, Kong S, Sun L, Du L, Liang S, Gao Z, Zheng G, Zheng M, Zhao C, Feng X, Wu G, Zhou H. Spironolactone Improves the All-Cause Mortality and Re-Hospitalization Rates in Acute Myocardial Infarction with Chronic Kidney Disease Patients. Front Pharmacol 2021; 12:632978. [PMID: 34135751 PMCID: PMC8201517 DOI: 10.3389/fphar.2021.632978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Mineralocorticoid receptor antagonists (MRA) improve outcomes in chronic kidney disease (CKD) and acute myocardial infarction (AMI) patients. However, the lack of evidence regarding long-term clinical outcomes in the use of MRA, including spironolactone, in patients with AMI combined with CKD. Objectives: This study aimed to investigate whether spironolactone could significantly reduce the risk of all-cause mortality and re-admission in patients with AMI and CKD. Methods: In this single center, observational, retrospective, registry based clinical study, a total of 2,465 AMI patients were initially screened; after excluding patients with estimated glomerular filtration rate more than 60 ml/min/1.73 m2, 360 patients in the standard treatment group and 200 patients in the spironolactone group met the criteria. All enrolled patients follow-up for 30 months. The primary outcomes were all-cause mortality and re-admission. The key safety outcome was hyperkalemia rates during the 30 months follow-up period. Results: 160 (44.4%) and 41 (20.5%) patients in the standard treatment and spironolactone groups died, respectively [hazard ratio (HR): 0.389; 95% confidence interval (CI): 0.276–0.548; p < 0.001]. Re-admission occurred in 217 (60.3%) and 95 (47.5%) patients in the standard treatment and spironolactone groups, respectively (HR: 0.664; 95% CI: 0.522–0.846; p = 0.004). The spironolactone group was divided into two based on the daily dose, low dose group (no more than 40 mg) and high dose group (more than 40 mg); the differences in the mortality rate between low dose group (16.7%) and the standard treatment group (44.4%) (HR: 0.309; 95% CI: 0.228–0.418; p < 0.001) and high dose group (34.1%) (HR: 0.429; 95% CI: 0.199–0.925; p = 0.007) were significant. The differences in re-hospitalization rate between low dose group (43.6%) and the standard treatment group (60.3%) (HR: 0.583; 95% CI: 0.457–0.744; p < 0.001) and high dose group (61.4%) (HR: 0.551; 95% CI: 0.326–0.930; p = 0.007) was significant. Hyperkalemia occurred in 18 (9.0%) and 18 (5.0%) patients in the spironolactone group and standard treatment group, respectively (HR: 1.879; 95% CI: 0.954–3.700; p = 0.068). Whereas, Hyperkalemia occurred in high dose group (20.5%) significantly more often than in the standard treatment group (p < 0.001) and low dose group (5.8%) (p = 0.003). Conclusion: Using MRA, such as spironolactone, may substantially reduce the risk of both all-cause mortality and re-admission in patients with AMI and CKD; the use of low-dose spironolactone has the best efficacy and safety. However, this was a relatively small sample size, single center, observational, retrospective, registry based clinical study and further prospective evaluation in adequately powered randomized trials were needed before further use of spironolactone in AMI with CKD population.
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Affiliation(s)
- Xiang Qu
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Hui Yao
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Changxi Chen
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Shuting Kong
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Lingyue Sun
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Leilei Du
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Siqi Liang
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Zhan Gao
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Gaoshu Zheng
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Minghua Zheng
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Chuhuan Zhao
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Xiafei Feng
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Gaojun Wu
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Hao Zhou
- Cardiovascular Medicine, First Affiliated Hospital of Wenzhou Medical University, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
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Yu S, Guo Q, Jia T, Zhang X, Guo D, Jia Y, Li J, Sun J. Mechanism of Action of Nicotiflorin from Tricyrtis maculata in the Treatment of Acute Myocardial Infarction: From Network Pharmacology to Experimental Pharmacology. Drug Des Devel Ther 2021; 15:2179-2191. [PMID: 34079221 PMCID: PMC8164440 DOI: 10.2147/dddt.s302617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Acute myocardial infarction (AMI) is a cardiovascular disease with a high fatality rate. In this study, we combined network pharmacology and experimental pharmacology and discovered the potential mechanism of action and the active ingredients of the lily, Tricyrtis maculata was discovered. The monomer compound with stronger activity was discovered through in vitro cell experiments. Methods Forty known compounds were isolated from T. maculata. Using TCMSP, Swiss Target Prediction, metaTarFisher, GeneCards and OMIM databases, targets of drug compositions and AMI-related genes were obtained, and the differential expression genes between AMI and normal tissues were extracted through the GEO database. Then, through an online mapping tool, the intersection genes were obtained to predict the possible effective components of T. maculata that can be used to treat AMI. The top five targets were selected for molecular docking via the protein–protein interaction (PPI) network to verify the binding activity between key compounds and target proteins. GO and KEGG enrichment analyses of the intersection genes were carried out with the program R to further screen key genes and effective compositions. On this basis, the compound with more optimal activity was screened and validated in vitro. Results In this study, 40 known monomer components were selected, and 1112 predicted genes, 1655 disease genes, 1425 differentially expressed genes, 1206 GO functions and 127 KEGG pathways were obtained. The results of molecular docking showed that the binding of MMP9 with drug components is stable. Through the comprehensive research of network pharmacology and experimental pharmacology, it was shown that T. maculata intervenes in the process of AMI through multicomponent, multitarget, and multichannel synergistic effects. It is speculated that the anti-AMI effect may be related to the regulation of the Akt/FoxO/BCl signaling pathway. Cellular experiments showed that nicotiflorin has satisfactory anti-inflammatory activity and endothelial protection and can reduce the release of nitric oxide (NO), an inflammatory medium after endothelial cell damage. Conclusion This study reveals the therapeutic effect and relative mechanism of extract of T. maculata extract on AMI. Analysis revealed that nicotiflorin from T. maculata is a compound with satisfactory anti-inflammatory activity and endothelial protection, which provides a new direction and treatment basis for further experimental exploration and clinical treatment.
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Affiliation(s)
- Shangshang Yu
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Qi Guo
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Tianqian Jia
- Haojing College of Shaanxi University of Science & Technology, Shaanxi, Xi'an, People's Republic of China
| | - Xiaofei Zhang
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Dongyan Guo
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Yanzhuo Jia
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Jia Li
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Jing Sun
- Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
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Lund JS, Aksetøy ILA, Dalen H, Amundsen BH, Støylen A. Left ventricular diastolic function: Effects of high-intensity exercise after acute myocardial infarction. Echocardiography 2020; 37:858-866. [PMID: 32497332 DOI: 10.1111/echo.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/20/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Reduced left ventricular (LV) diastolic function indicates poor prognosis after acute myocardial infarction (AMI). Our aim was to study whether a twelve-week high-intensity interval training program could improve diastolic function in patients with a relatively recent AMI. DESIGN Twenty-eight patients (mean age 56 (SD 8) years) with a recent AMI performed high-intensity interval training twice a week for 12 weeks. Each training session consisted of four 4-minute bouts at 85%-95% of peak heart rate, separated by 4-minute active breaks. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO2peak ). Echocardiography was performed at rest and during an upright bicycle exercise test. RESULTS There was a significant increase in mitral annulus early diastolic velocity (e') at peak exercise (75 W) from baseline to follow-up (7.9 (1.5) vs. 8.4 (1.7) cm/s, P = .012), but no change in e' at rest (7.1 (1.9) vs. 7.3 (1.7) cm/s, P = .42). There was a significant increase in VO2peak (mean (SD), 35.2 (7.3) vs. 38.9 (7.4) ml/kg/min, P < .001). e' at peak exercise correlated with VO2peak both at baseline and follow-up (r = 0.50, P = .007, and r = 0.41, P = .032). CONCLUSION The present study shows that LV diastolic function during exercise is related to VO2peak . We also found an improvement of diastolic function after exercise training, even in a population with a relatively well preserved systolic and diastolic function. The results demonstrate the importance of obtaining measurements during exercise when evaluating the effects of exercise interventions.
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Affiliation(s)
- Joakim Schistad Lund
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Inger-Lise Aamot Aksetøy
- K.G. Jebsen Centre of Exercise in Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håvard Dalen
- K.G. Jebsen Centre of Exercise in Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brage Høyem Amundsen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asbjørn Støylen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Xiang Y, Shi W, Li Z, Yang Y, Wang SY, Xiang R, Feng P, Wen L, Huang W. Efficacy and safety of spironolactone in the heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction: A meta-analysis of randomized clinical trials. Medicine (Baltimore) 2019; 98:e14967. [PMID: 30921200 PMCID: PMC6456096 DOI: 10.1097/md.0000000000014967] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent studies have shown the efficacy for using spironolactone to treat heart failure with reduced ejection fraction (HFrEF), but the efficacy of spironolactone for heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) is unclear. This meta-analysis investigated the efficacy and safety of spironolactone in patients with HFmrEF and HFpEF. METHODS AND RESULTS We searched several databases including PubMed and the Cochrane Collaboration, for randomized controlled trials (RCTs) that assessed spironolactone treatment in HFmrEF and HFpEF. Eleven RCTs including 4539 patients were included. Spironolactone reduced hospitalizations (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.95; P = .006), improved New York Heart Association functional classifications (NYHA-FC) (OR, 0.35; 95% CI, 0.19-0.66; P = .001), decreased the levels of brain natriuretic peptide (BNP) (mean difference [MD], - 44.80 pg/mL; 95% CI, -73.44--16.17; P = .002), procollagen type I C-terminal propeptide (PICP) (MD, -27.04 ng/mL; 95% CI, -40.77--13.32, P < .001) in HFmrEF and HFpEF. Besides, it improved 6-minute walking distances (6-MWD) (standard weighted mean difference [SMD], 0.45 m; 95% CI, 0.27-0.64; P < .001), decreased amino-terminal peptide of procollagen type-III (PIIINP) (SMD, -0.37 μg/L; 95% CI, -0.59--0.15; P = .001) in HFpEF only. The risks of hyperkalemia (P<.001) and gynecomastia (P<.001) were increased. CONCLUSION Patients with HFmrEF and HFpEF could benefit from spironolactone treatment, with reduced hospitalizations, BNP levels, improved NYHA-FC, alleviated myocardial fibrosis by decreasing serum PICP in HFmrEF and HFpEF, decreased PIIINP levels and increased 6-MWD only in HFpEF. The risks of hyperkalemia and gynecomastia were significantly increased with the spironolactone treatment.
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Affiliation(s)
- Yajie Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhai Shi
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuolin Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunjing Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Panpan Feng
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Wen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, Dominic P, Modi K. Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:913-920. [PMID: 29799995 PMCID: PMC6145720 DOI: 10.1001/jamainternmed.2018.0850] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Treatment with aldosterone antagonists is recommended and has been shown to have beneficial effects in patients with ST-segment elevation myocardial infarction (STEMI) and left ventricular ejection fraction (LVEF) less than 40%. However, the role of aldosterone antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known. OBJECTIVES To perform a systematic review and meta-analysis using standard techniques to determine the role of therapy with aldosterone antagonists in this patient population. DATA SOURCES PubMed, Embase, CINAHL, and Cochrane Central databases were searched and a manual search for relevant references from the selected articles and published reviews was performed from database inception through June 2017. STUDY SELECTION Randomized clinical trials that evaluated treatment with aldosterone antagonists in patients with STEMI without clinical heart failure or LVEF greater than 40% were included. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct and report the meta-analysis, which used a random-effects model. Two investigators independently performed the database search and agreed on the final study selection. A manual search was performed for relevant references from the selected articles and published reviews. MAIN OUTCOMES AND MEASURES The outcomes analyzed were mortality, new congestive heart failure, recurrent myocardial infarction, ventricular arrhythmia, and changes in LVEF, serum potassium level, and creatinine level at follow-up. RESULTS In all, 10 randomized clinical trials with a total of 4147 unique patients were included in the meta-analysis. In patients who presented with STEMI without heart failure, treatment with aldosterone antagonists compared with control was associated with lower risk of mortality (2.4% vs 3.9%; odds ratio [OR], 0.62; 95% CI, 0.42-0.91; P = .01) and similar risks of myocardial infarction (1.6% vs 1.5%; OR, 1.03; 95% CI, 0.57-1.86; P = .91), new congestive heart failure (4.3% vs 5.4%; OR, 0.82; 95% CI, 0.56-1.20; P = .31), and ventricular arrhythmia (4.1% vs 5.1%; OR, 0.76; 95% CI, 0.45-1.31; P = .33). Similarly, treatment with aldosterone antagonists compared with control was associated with a small yet significant increase in LVEF (mean difference, 1.58%; 95% CI, 0.18%-2.97%; P = .03), a small increase in serum potassium level (mean difference, 0.07 mEq/L; 95% CI, 0.01-0.13 mEq/L; P = .02), and no change in serum creatinine level (standardized mean difference, 1.4; 95% CI, -0.43 to 3.24; P = .13). CONCLUSIONS AND RELEVANCE Treatment with aldosterone antagonists is associated with a mortality benefit in patients with STEMI with LVEF greater than 40% or without heart failure.
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Affiliation(s)
- Khagendra Dahal
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Aditya Hendrani
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Sharan P Sharma
- Department of Medicine, LRGHealthcare, University of New England, Laconia, New Hampshire
| | - Sampath Singireddy
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - George Mina
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Pratap Reddy
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Paari Dominic
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Kalgi Modi
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
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Mineralocorticoid receptor antagonists in patients with acute myocardial infarction - A systematic review and meta-analysis of randomized trials. Am Heart J 2018; 195:60-69. [PMID: 29224647 DOI: 10.1016/j.ahj.2017.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although mineralocorticoid antagonists (MRAs) reduce mortality in patients with heart failure complicating myocardial infarction (MI), it is unclear if they could be beneficial to all patients with MI. To evaluate the utility of MRAs in MI patients, we performed a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 1965 to June 2016. Conference abstracts were searched from 2000 to June 2016. Randomized trials evaluating the effect of MRA after MIs were included. Two reviewers independently extracted data and assessed study quality. Data were combined using fixed-/random-effects models. RESULTS Eleven randomized clinical trials (N = 11,258) were included; 1 trial (N = 6,642) included patients with apparent heart failure (Killip class III-IV). Administration of MRA versus placebo or standard therapy (no-MRA) after MI reduced overall and cardiovascular mortality (odds ratio [OR] 0.82, 95% CI 0.73-0.93, P = .002, and OR 0.82, 95% CI 0.71-0.93, P = .003, respectively; I2 for both = 0%). In the subgroup of trials with patients with heart failure, the mortality was 14.4% in MRA group versus 16.7% in no-MRA group (OR 0.84, 95% CI 0.73-0.96), and among those without heart failure, it was 2.5% with MRA versus 3.5% without MRA (OR 0.72, 95% CI 0.51-1.02, P for interaction = .43). Patients receiving MRA had fewer new or worsening heart failure events (OR 0.74, 95% CI 0.66-0.84, P < .0001; I2 = 14%). Nevertheless, MRA therapy increased risk for hyperkalemia (≥5.5 mmol/L) (OR 2.52, 95% CI 1.36-4.65, P = .003; I2 = 63%). CONCLUSIONS Administration of MRA may reduce mortality after acute MI. However, this is largely based on post-MI patients with heart failure. Further data are needed in MI patients without heart failure.
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Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, Janiaud P, Marchant I, Cucherat M, Bejan-Angoulvant T, Gueyffier F. Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2016; 11:e0145958. [PMID: 26891235 PMCID: PMC4758660 DOI: 10.1371/journal.pone.0145958] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 12/10/2015] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. Methods We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). Results Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67–0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74–0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70–0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66–0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76–0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74–0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71–0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77–0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74–0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased. Conclusion Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.
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Affiliation(s)
- Hai-Ha Le
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Chadia El-Khatib
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Margaux Mombled
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Frédéric Guitarian
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Muaamar Al-Gobari
- Lausanne University Hospital (CHUV), Institute of social & preventive medicine (IUMSP), Lausanne, Switzerland
| | - Mor Fall
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Perrine Janiaud
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Ivanny Marchant
- Escuela de Medicina, Departamento de Pre-clínicas, Universidad de Valparaíso, Valparaíso, Chile
| | - Michel Cucherat
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Théodora Bejan-Angoulvant
- CHRU de Tours, Service de Pharmacologie Clinique, Hôpital Bretonneau, Tours, France
- CNRS UMR 7292, Tours, France
- Université François-Rabelais, GICC, Tours, France
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
- Service de Pharmacologie Clinique et essais thérapeutiques, Hospices Civils de Lyon, Lyon, France
- * E-mail:
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Cabiddu R, Trimer R, Monteiro CI, Borghi-Silva A, Trimer V, Carvalho P, Rocha T, Paredes S, Bianchi AM, Henriques J. Correlation between autonomous function and left ventricular performance after acute myocardial infarction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3343-6. [PMID: 26737008 DOI: 10.1109/embc.2015.7319108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Reduced ejection fraction (EF), possibly induced/mediated by autonomic abnormal activation, is one of the most powerful predictors of adverse outcome after acute myocardial infarction (MI). A deep understanding of the correlation between the autonomous functionality and the left ventricular performance in these patients is therefore of paramount importance. The autonomous function is reflected in the cardiac activity and, specifically, in the heart rate variability (HRV) signal. Given the cardiac activity nonlinearity, growing interest is being manifested towards nonlinear methods of analysis, which might provide more significant information than the traditional linear approaches. The aim of the present study was to investigate if non-linear HRV metrics change between MI patients with preserved EF (pEF) and MI patients with reduced EF (rEF). Data were acquired in the context of the cardioRisk project. Ten MI patients with rEF and six MI patients with pEF, admitted to Intensive Cardiac Care after a first acute MI episode, were studied. The ECG was acquired during a Holter recording and the tachogram was extracted. Sample entropy (SE) and Lempel-Ziv Complexity (LZC 1 and LZC 2) metrics were computed on five hour long tachogram portions. A significant correlation was found between LZC indices and EF in the whole population; SE, LZC 1 and LZC 2 were significantly higher in patients with pEF. Our results indicate that lower complexity characterizes the HRV of MI patients with rEF. Complexity reduction might be due to a simplification of regulatory mechanisms, which might explain why MI patients with rEF are at higher risk for subsequent non-fatal and fatal events.
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Chen Y, Wang H, Lu Y, Huang X, Liao Y, Bin J. Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials. BMC Med 2015; 13:10. [PMID: 25598008 PMCID: PMC4307751 DOI: 10.1186/s12916-014-0261-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/17/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) have been shown to be effective in patients with heart failure or myocardial infarction complicated by a reduced ejection fraction. However, the role of MRAs in patients with preserved ejection fraction (PEF) remains to be clarified. We aimed to summarize the evidence for the efficacy of MRAs in patients with either heart failure with PEF (HF-PEF) or myocardial infarction with PEF (MI-PEF). METHODS We searched PubMed, EMBASE, Cochrane Library, and clinical trials databases for randomized controlled trials, through June 2014, assessing MRA treatment in HF-PEF or MI-PEF patients. Fourteen randomized controlled trials (MI-PEF, 5; HF-PEF, 9; n = 6,428 patients) were included. RESULTS MRA treatment reduced the risk of hospitalization for heart failure (relative risk, 0.83; 95% confidence interval [CI], 0.70 to 0.98), improved quality of life (weighted mean difference [WMD], -5.16; 95% CI, -8.03 to -2.30), left ventricular end-diastolic diameter (standardized mean difference, -0.21; 95% CI, 0.32 to -0.11), and serum amino-terminal peptide of procollagen type-III level (WMD, -1.50, 95% CI, -1.72 to -1.29) in patients with PEF. In addition, MRAs reduced E/e'(an echocardiographic estimate of filling pressure for assessment of diastolic function; WMD, -1.82; 95% CI, -2.23 to -1.42) in HF-PEF patients and E/A ratio (the ratio of early to late diastolic transmitral flow; WMD, 0.12; 95% CI, 0.10 to 0.14) in MI-PEF patients. However, all-cause mortality was not improved by MRAs in either HF-PEF (P = 0.90) or MI-PEF (P = 0.27) patients. CONCLUSIONS MRA treatment in PEF patients led to reduced hospitalization for heart failure, quantifiable improvements in quality of life and diastolic function, and reversal of cardiac remodeling, but did not provide any all-cause mortality benefit.
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Affiliation(s)
- Yanmei Chen
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - He Wang
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Yongkang Lu
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Xiaobo Huang
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Yulin Liao
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Jianping Bin
- State Key Lab for Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
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Wu CT, Wang ZH, Li ZQ, Wang LF. Effect of spironolactone on cardiac remodeling after acute myocardial infarction. World J Emerg Med 2014; 4:48-53. [PMID: 25215092 DOI: 10.5847/wjem.j.issn.1920-8642.2013.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI. METHODS A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up. RESULTS The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LAD-SI were significantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more significantly improved at one year than one month (P=0.0277). There were no significant differences in serum potassium and serum creatinine levels between the two groups. CONCLUSION On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.
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Affiliation(s)
- Chun-Tao Wu
- Department of Cardiology, Second Affiliated Hospital, Qiqihar Medical College, Qiqihar 161006, China
| | - Zhong-Hua Wang
- CCU, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Zhu-Qin Li
- CCU, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Lan-Feng Wang
- CCU, First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
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