Mineralocorticoid Antagonists and Heart Failure: Off the Bench, Into the Game

In previous studies, spironolactone reduced mortality in patients with moderate-to-severe heart failure (HF) symptoms, and eplerenone reduced mortality in patients with left ventricular systolic dysfunction and HF after acute myocardial infarction. Now, in an industry-sponsored, placebo-controlled trial, investigators have examined whether adding eplerenone to evidence-based HF drug treatment reduces the composite of cardiovascular death and first HF hospitalization in 2737 patients (average age, 69; 22% women) with systolic HF and mild symptoms. Patients with baseline potassium levels >5.0 mmol/L or estimated glomerular filtration rates <30 mL/minute/1.73 m² were excluded.

The trial was stopped early when an interim analysis showed a compel…