Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction

Xu, Yan; Qiu, Zhiqiang; Yang, Runqiang; Wu, Yanqing; Cheng, Xiaoshu

doi:10.1097/md.0000000000013690

Cited by 4 publications

(4 citation statements)

References 40 publications

(58 reference statements)

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“…40 RAASi TherapydBenefits and Hyperkalemia Risk Renin-angiotensin-aldosterone system inhibitors are recommended for patients with hypertension, 42 HF, 43,44 stable coronary artery disease, 45 CKD, diabetic kidney disease (DKD), 46 and diabetes. 47,48 They improve survival in patients with CKD, 49 HF, 50,51 and post-MI status 52 and also provide kidney benefits in patients with non-DKD 53 and DKD. 54,55 Many patients who would otherwise benefit from RAASis either do not receive FIGURE 1.…”

Section: Risk Factorsmentioning

confidence: 99%

Clinical Management of Hyperkalemia

Palmer

Carrero

Clegg

et al. 2021

Mayo Clinic Proceedings

110

106

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Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K þ) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K þ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K þ-binding agents. Monitoring serum K þ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K þ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K þ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K þ-binding agents requires further study to establish whether stringent dietary K þ restrictions are needed in patients receiving K þ-binder therapy. Individualized monitoring of serum K þ among patients with an increased risk of hyperkalemia and the use of newer K þ-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.

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Section: Risk Factorsmentioning

confidence: 99%

Clinical Management of Hyperkalemia

Palmer

Carrero

Clegg

et al. 2021

Mayo Clinic Proceedings

110

106

View full text Add to dashboard Cite

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“…Although these drugs may reduce symptoms, it has been reported the difficulty to improve cardiovascular outcomes by using diuretics. 29,30 It has been showed that the treatment with mineral corticoid receptor antagonists decreased all cause-mortality and cardiovascular death in post-MI patients with left ventricular dysfunction, whereas did not exhibit any cardiovascular benefit in those without left ventricular dysfunction. 31 Recently, diuretics use (furosemide was the one most frequently administered) 32 has been considered the strongest clinical predictor of cardiovascular events in patients with HF, and in those with a previous MI and impaired glucose tolerance.…”

Section: Resultsmentioning

confidence: 99%

“…Diuretics represent a widespread pharmacological treatment in patients with concomitant hypertension or HF. Although these drugs may reduce symptoms, it has been reported the difficulty to improve cardiovascular outcomes by using diuretics 29,30 . It has been showed that the treatment with mineral corticoid receptor antagonists decreased all cause‐mortality and cardiovascular death in post‐MI patients with left ventricular dysfunction, whereas did not exhibit any cardiovascular benefit in those without left ventricular dysfunction 31 .…”

Section: Discussionmentioning

confidence: 99%

Detection of sieric BAG3 in patients affected by cardiovascular diseases: State of art and perspectives

Maffioli

D’Angelo

Tinelli

et al. 2021

J of Cellular Biochemistry

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BAG3 is highly expressed in the heart and its functions are essential in maintaining cardiac muscle cells homeostasis. In the past, BAG3 was detected in serum from advanced heart failure patients and its higher levels were correlated to an increased death risk. Moreover, it has also been reported that BAG3 levels in serum are increased in patients with hypertension, a known cardiovascular risk marker. Evidence from different laboratories suggested the possibility to use BAG3‐based strategies to improve the clinical outcome of cardiovascular disease patients. This review aims to highlight the biological roles of intracellular or secreted BAG3 in myocardiocytes and propose additional new data on the levels of sieric BAG3 in patients with acute myocardial infarction (AMI), never assessed before. We evaluated BAG3 serum levels in relation to cardiovascular risk parameters in 64 AMI patients aged ≥18 years of either sex. We observed significant (p < .01) correlations of BAG3 positivity with dyslipidemic status and diabetic disease. We did not observe any significant correlations of BAG3 levels with smoking habit, hypertension or familiarity for AMI, although BAG3‐positive seemed to be more numerous than BAG3‐negative patients among hypertensives and among patients with familiarity for AMI. Furthermore, a significant (p < .001) correlation of BAG3 positivity with diuretics assumption was also noted. In conclusion, 32.8% of the patients were BAG3‐positive and were characterized by some particular features as comorbidity presence or concomitant therapies. The significance of these observations needs to be verified by more extensive studies and could help in the validation of the use of BAG3 as a biomarker in heart attack risk stratification.

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“… 8 MRA has also been shown to be beneficial for patients with a reduced EF in the postmyocardial infarction setting. 43 MRA should be discontinued in patients in whom serum potassium cannot be maintained less than 5.5 mEq/L and should not be used in women with serum creatinine above 2.0 mg/dL and in men with creatinine above 2.5 mg/dL 8 because of the excess risk of hyperkalemia.…”

Section: Heart Failure With Reduced Ejection Fractionmentioning

confidence: 99%