Drug Reduces Death Risk in Heart Attack Patients

A drug that blocks a heart-harming hormone significantly reduces the risk of death and hospital stay in heart attack patients who have heart failure, according to a new international study. The study was published in the April 3, 2003, issue of The New England Journal of Medicine.

The randomized, placebo-controlled study involved 6,632 patients in 37 countries. The life-saving effect was especially strong if patients were also on other heart medications. If these patients had also undergone coronary reperfusion, they had a 26% reduction in mortality, compared to those in the placebo group. Other patients receiving the drug had 15% fewer deaths and 13% fewer cardiovascular-related deaths and hospitalizations. The drug, eplerenone (Inspra), is the product of Pharmacia Corp. (Peapack, NJ, USA) and has recently been cleared by the US Food and Drug Administration (FDA) for the treatment of hypertension.

Both eplerenone and another drug, spironolactone, block the effects of aldosterone, a hormone known to damage heart muscle and, in conjunction with angiotensin II, can cause blood vessel damage. The use of spironolactone has often led to hyperkalemia, impotence, and breast swelling in men. While the current trial of eplerenon showed an increased incidence of hyperkalemia, especially in patients whose kidneys were less able to remove creatinine from the body, it did not show the other side effects of spironolactone.

"This represents a new advance in the treatment of heart attack and heart failure,” said Bertram Pitt, M.D., a cardiologist at the University of Michigan (U-M, Ann Arbor, USA), who led the study. "This hormone is turning out to be more important than anyone thought.”




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