Diuretic lessens risk of death from mild heart failure: Study

A new study shows that diuretic pill Inspra (generic – Eplerenone) cuts down the risk of death and hospitalization among people with mild heart failure. The drug that is widely used to treat advanced heart failure, also has value for people with mild disease, says lead researcher Faiez Zannad, of Nancy University in Nancy, France. The results were reported at the American Heart Association's annual meeting and published simultaneously online in the New England Journal of Medicine.

The two year old study has shown that Inspra reduced the risk of dying from heart disease or being hospitalized for heart failure by 37%, compared with placebo. The trial involved 2,737 patients 55 or older with mild heart failure. They were given either Inspra or placebo. Compared to 16% patients dying while on placebo, 13% patients on Inspra succumbed to the disease. Also, 12% of patients on Inspra were hospitalized for heart failure, compared with nearly 19% of those on placebo. Participants continued to take their standard medications, which typically included an ACE inhibitor, an angiotensin receptor blocker (ARB), or both, and a beta-blocker. The study was stopped early because of Inspra’s overwhelming benefits. Side effects were slightly less common in the Inspra group: 13.8% vs. 16.2% for placebo.

The interpretation stands that 19 people would need to be treated for one year to prevent one death due to heart disease or heart failure hospitalization, and 51 to prevent one death.

In an accompanying editorial in the journal Paul W. Armstrong of the University of Alberta in Edmonton writes that this “position[s] this therapy in the front rank of therapeutic choices.” At present nearly 5 million Americans have heart failure wherein their heart becomes weak and loses its ability to pump enough blood throughout the body leading to progressive illness that kills the patient with fluid accumulation in the lungs and severe breathlessness. Inspra, made by Pfizer Inc., which funded the study, helps block water retention. Dr. Armstrong wrote that widely used spironolactone may be an alternative to Inspra. It costs less than $30 a month vs. more than $130 for a 30-day supply of Inspra. He calls reserving the more expensive drug as a “reasonable tactic.”

According to the University of Pennsylvania’s Mariell Jessup, the new findings have the potential to change how doctors treat people with mild heart failure. Dr. Clyde Yancy, of Baylor University Medical Center in Dallas added that some patients may prefer Inspra because it does not cause breast enlargement in men and loss of libido in women. Spironolactone causes these side effects in about 10% of patients. Dr. Yancy also said that these new findings may find a place in the 2011 guidelines to treat heart failure. He also added that at present one-third of people with advanced heart failure who are candidates for Inspra or spironolactone get the drugs. He added, “Hopefully these findings will push more doctors to use them” in people with mild and advanced disease, unless there is a medical reason not to.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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