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Aldosterone Blocker May Lower Death, Heart Failure Risks After a Heart Attack

(CHICAGO)— April 1, 2003 - Beta blockers, angiotensin-converting-enzyme (ACE) inhibitors, and other drugs have been added in recent years to the list of drugs heart-attack patients should be taking. Now many such patients, those who have been left with symptoms of poor heart function, should also be on a drug from yet another class, the aldosterone-receptor blockers, according to a large randomized, controlled study.

In the Eplerenone Post-AMI Heart Failure Efficacy and Survival Study (EPHESUS), more than 6,600 patients with symptoms of poor heart function 3-14 days after a heart attack were randomly assigned to receive either eplerenone or placebo. Both groups received current standard medical care that could include statins, beta blockers, and ACE inhibitors. Those who received the test drug, a recently developed aldosterone-receptor blocker, had a significantly reduced risk of death and of death or hospitalization.

“Aldosterone blockade can further reduce mortality and morbidity on top of standard therapy and should represent a new class of therapy in this group of patients,” according to Dr. Bertram Pitt, University of Michigan, Ann Arbor. Aldosterone blockers such as the long-established spironolactone and the newcomer eplerenone have been used in patients with hypertension for decades and only lately in those with severe heart failure. The EPHESUS study suggests that eplerenone can be extended to another group of patients in hopes their risk of death or heart failure can be lowered.

The formal results are scheduled to be published simultaneously on the Web site of the New England Journal of Medicine.

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