The American College of Cardiology

In: Health

6 Jul 2010


Aldosterone Blocker in Diabetic Hypertensive Proteinuria

Speaker: Murray Epstein, MD, Professor of Medicine, Nephrology and Hypertension, University of Miami School of Medicine, Miami, Florida.

Eplerenone (Pharmacia), the first selective aldosterone blocker, provided substantial reduction in proteinuria in hypertensive patients with diabetes, compared to the ACE-inhibitor enalapril (Merck), with the two together being even more effective despite similar blood pressure (BP) lowering, thus indicating that renal protection is independent of BP reduction and that selective aldosterone antagonism is renoprotective.

Because preliminary evidence from preclinical and clinical studies suggests that aldosterone contributes to the progression of hypertension and heart failure and might promote renal dysfunction, a study was carried out to investigate whether the selective aldosterone receptor antagonist (SARA) eplerenone would reduce proteinuria in hypertensive patients with type 2 diabetes mellitus and albuminuria. Current antihypertensive agents, such as ACE-inhibitors and angiotensin II receptor blockers (ARBs), do not fully block the effects of aldosterone.

The study compared three antihypertensive strategies: the effects of eplerenone (200 mg), enalapril (40 mg), and eplerenone (100 mg) in combination, all given once daily, randomly assigned to 257 type 2 diabetic patients with hypertension and albuminuria, over a 24-week period. Eplerenone reduced urinary albumin to creatinine ratio (UACR) by 62% compared to 45% with canadian enalapril, and the combination was even more effective against either eplerenone or enalapril alone (74%). Blood-pressure lowering was equivalent in all three treatment groups (eplerenone: -19.5/-13.2; enalapril: -20.4/-15.0; and combination: -21.8/-16.2).

Statin for Preventing Post-PCI Cardiovascular Events

Speaker: Patrick W. Surruys, MD, Professor of Medicine, Throaxcenter, Erasmus University Hospital, Rotterdam, The Netherlands.

The use of early statin therapy with fluvastatin (Lescol, Novartis) in patients following their first percutaneous coronary interventions (PCIs) significantly reduces their risk for major adverse coronary events, according to results from the Lescol Intervention Study (LIPS).

The LIPS study was a double-blind, randomized trial designed to compare the effect of fluvastatin (40 mg twice daily) on a major adverse coronary event—cardiac death, non-fatal MI, or repeat coronary artery bypass graft [CABG] or PCI. The event-free survival time was studied in 1,677 patients with coronary heart disease who had recently undergone a first angioplasty or PCI, over a three-year follow-up period.

Patients taking the statin, which was initiated 2.7 days after the procedure, had LDL-cholesterol levels of 137 mg/dL on average, over a three- to four-year period. Those on the statin had a 22% risk reduction for major adverse cardiac events. Looking at secondary endpoints, it was found that fluvastatin also lowered the risk for major adverse coronary events in patients with diabetes or multilevel diseases.

Combination Therapy for Diabetic Patients with MIs Speaker: Hitinder Gurm, Cardiology Fellow, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

Although patients with diabetes are at significantly higher risk for ST-segment elevation myocardial infarction (MI) compared to non-diabetics, over the past few years, the increased use of therapy combining beta blockers and ACE-inhibitors has improved survival of these patients, as evidenced by a lower incidence of recurring MI, a less frequent need for urgent revascularization, and fewer incidents of malignant ventricular arrhythmias.

Meeting Highlights: American College of Cardiology

To reach these conclusions, the data from patients with diabetes who were enrolled in GUSTO (Global Use of Strategies to Open Occluded Arteries in Acute Myocardial Infarction) I, III, and V trials were analyzed to define the trends in the use of adjunctive therapies and in short-term outcomes. The three GUSTO trials enrolled 9,200 patients with diabetes and 52,509 non-diabetics, all with ST-segment elevation MI.

The comparison of treatments in GUSTO I and III versus GUSTO V, which was completed in 2001, pointed out that patients with diabetes were consistently more likely than other patients to die in the hospital or within 30 days thereafter, but the increased use of beta blockers and ACE-inhibitors in the most recent trial (GUSTO V) improved survival (30-day mortality: 10.7%^-GUSTO I, 10.9%^-GUSTO III, 8.9%^-GUSTO V). canadian cialis online

In addition, patients with diabetes who did not receive combination therapy were more likely to have a second MI. They were also more likely to need to undergo urgent coronary artery bypass graft (CABG) surgery or stenting within seven days post-MI.

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