Eplerenone shows benefit for patients with damaged hearts

In the first thirty days following a heart attack, one in three deaths among patients with signs of heart failure may be preventable by early treatment with a drug called eplerenone (Inspra, Pfizer Ltd), according to new data published in the Journal of the American College of Cardiology (JACC).

Results from the study show that eplerenone reduced death rate from all causes in the first 30 days after a heart attack by 31% when given to hospital patients. All the patients in the study had heart failure because the left ventricle (pumping chamber) of their heart had been damaged by their heart attack.

Dr Ian Squire, Senior Lecturer in Medicine/Consultant Physician, Coronary Care Unit, Leicester Royal Infirmary, who participated in the study data collection said: "These new findings clearly demonstrate the importance of early treatment with eplerenone for appropriate patients who have survived a heart attack. Starting eplerenone within 30 days of hospital admission maximizes the benefit of this therapy."

Professor Martin Cowie, Professor of Cardiology, Imperial College, London and Honorary Consultant Cardiologist at the Brompton Hospital, London, commented: "Reducing mortality after a heart attack has been a great success story over the last two decades. The new analysis takes this story forward - the take home message is that there is substantial clinical benefit if treatment with eplerenone is initiated in the coronary care unit. Given to appropriate patients this treatment further reduces mortality following a heart attack."

Each year almost 270,000 people in the UK suffer a heart attack. Of these about one in three die before reaching hospital. The survivors have a high risk of heart failure. Of the 65,000 new cases of heart failure occurring in the UK each year, it is estimated that 15,000 follow a heart attack .

Eplerenone, given as tablets, works by blocking the actions of a hormone called aldosterone. Following a heart attack this hormone may damage the ventricles (pumping chambers of the heart) via a number of mechanisms - including disruption of electrical conduction and stimulating the formation of collagen which changes the shape and function of the ventricle. Blocking the action of aldosterone is thought to prevent or ameliorate this harmful ventricular remodelling .

Dr Simon Williams, a cardiologist at Wythenshawe Hospital Manchester, who has a special interest in heart failure commented: "Most people discharged from hospital following a heart attack will have been started on aspirin, a beta blocker, a statin and an ACE inhibitor - however none of these agents influence the aldosterone system. The addition of the selective aldosterone blocker eplerenone to these standard treatments confers extra benefit - moreover the clear message from this study is the importance of starting eplerenone in the hospital coronary care unit rather than a few months later."

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