Altbewährtes neu entdeckt - Aldosteronantagonisten und chronische Herzinsuffizienz

Zusammenfassung

In der neurohormonalen Theorie der Herzinsuffizienz spielt Aldosteron eine bedeutsame Rolle, durch seine Effekte auf die Endothelfunktion, auf die glatte Gefäßmuskulatur, auf die Adventitia, auf den PAI-1 (Plasminogen-Aktivator-Inhibitor-1) und auf die Fibrosierung des Myokards. Der therapeutische Ansatz mit Aldosteronantagonisten konnte sowohl tierexperimentell als auch in klinischen Studien (RALES, EPHESUS) eine günstige Wirkung auf die Herzinsuffizienzentwicklung zeigen sowie die Mortalität signifikant verbessern, wobei auf eine Niereninsuffizienz und engmaschige Kaliumkontrollen besonders geachtet werden muss.

Summary

Aldosterone has an important role in the neurohumoral pathophysiology of heart failure. This is caused by aldosterone effects on endothelium, smooth muscle cells, adventitia, PAI-1 and fibrosis of the myocardium. Experimental studies with aldosterone-antagonists were able to show a positive effect on the development of heart failure and large clinical trials could prove a significant reduction of mortality in patients with left ventricular dysfunction (RALES, EPHESUS). Close monitoring of potassium and renal failure is crucial for safe therapy with aldosterone-receptor-antagonists.

Key Words

aldosterone - heart failure - spironolactone - eplerenone - RALES - EPHESUS

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1 randomized evaluation of strategies for left ventricular dysfunction

2 randomized aldactone evaluation study

3 eplerenone post-acute myocardial infarction heart failure efficacy and survival trial

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