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J Thorac Cardiovasc Surg 2009;137:257
© 2009 The American Association for Thoracic Surgery

Letter to the Editor

Spironolactone alleviates late cardiac remodeling after left ventricular restoration

Department of Internal Medicine, University of Arizona College of Medicine, Tucson, Ariz

To the Editor:

Tsukashita et al¹ have performed an excellent experimental study to show that spironolactone alleviates remodeling after left ventricular restoration.

When experimental studies are translated into clinical practice, great caution should be maintained. Previous clinical studies on spironolactone showed a major impact on the prescribing patterns of the doctors. After the publication of the RALES study, there was an enormous increase in the prescription and usage of spironolactone in the late 1990s, leading to increased hospitalizations mostly due to hyperkalemia.² This was attributed to lack of clinical and laboratory monitoring, increased doses in patients with diabetes mellitus, renal dysfunction, left ventricular ejection fraction < 20%, and elderly patients.² Approximately 7.5 million of the elderly patients in the United States have a glomerular filtration rate < 60 mL/min, and in these patients, spironolactone causes increased adverse reactions.³ Microalbuminuria is a risk factor for heart failure with previous myocardial ischemia, and spironolactone has been demonstrated to reduce microalbuminuria when added to angiotensin-converting enzyme inhibitors.^4,5

Although spironolactone improves heart failure symptoms and decreases microalbuminuria, it should be used in a selected group of patients. We need further clinical studies that evaluate the side effect profile to show the same benefit in humans for alleviating remodeling following the success of the experimental study by Tsukashita et al.¹

References

1. Tsukashita M, Marui A, Nishina T, et al. Spironolactone alleviates late cardiac remodeling after left ventricular restoration surgery. J Thorac Cardiovasc Surg 2008;136:58-64.[Abstract/Free Full Text]
   
2. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004;351:543-551.[Medline]
   
3. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1-12.[Medline]
   
4. Bianchi S, Bigazzi R, Campese VM. Antagonists of aldosterone and proteinuria in patients with CKD: an uncontrolled pilot study. Am J Kidney Dis 2005;46:45-51.[Medline]
   
5. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000;356:366-372.[Medline]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ramaraj, R. Search for Related Content PubMed Articles by Ramaraj, R. Related Collections Congestive Heart Failure