Spironolactone for heart failure - Diegori.it

Spironolactone for heart failure13/06/2011 17:04and diuretic therapy.Best regardsSergio Kaiser, MDThese are important points. The SOLVD study looked at the benefit of enalapril inpatients with CHF. The article referred to by Dr. Kaiser is a retrospective study ofpatients enrolled in SOLVD and found that use of non-potassium sparing diuretics, butnot potassium-sparing diuretics, was associated with an increased risk of arrhythmicdeath. Unfortunately, the exact type of potassium-sparing diuretics was not specified, soit is impossible to know whether the majority of patients taking potassium-sparingdiuretics were taking spironolactone or triamterene (not an aldosterone antagonist).If most of these patients were taking spironolactone, then much of the benefit seen in thissubgroup in SOLVD might actually be due to aldosterone antagonism (as hypothesizedhere, in RALES), rather than to the prevention of potassium depletion. If, on the otherhand, a significant benefit was also present in patients taking triamterene, then one wouldhave to postulate a beneficial effect simply due to the prevention of potassium loss.Prevention of potassium loss alone, however, probably does not account for all of thebenefit seen in RALES, since an effect was seen on death from progressive CHF also, notonly from arrhythmia.As for beta-blockers and aldosterone antagonism, a beneficial effect of spironolactonewas also seen in the subgroup of patients taking beta-blockers, but as you point out, thisrepresents only 10% of the study population. --mjDate: November 11, 1999From: Agostino Colli [agcolli@tin.it]In RALES the number of patients in atrial fibrillation is not stated. Evenif one could suppose it from the number of patients on digitalis ( 70%)which is just the same in both groups, balancing with respect to thisfeature is not shown.It is true that the number of patients in atrial fibrillation was not specified. Presumablydigitalis was given for heart failure, not for fibrillation, in the majority of patients studiedhere. However, I'm not sure that spironolactone would be likely to have more or less ofan effect in patients in fibrillation, so even if the groups were unbalanced in this regard, Idon't think it would have affected the outcome. -- mjJanuary 24, 2000From: Javier Ena (jena@san.gva.es)Received: November 30, 1999I read with great interest your article and I was surprised by the large proportion of patients thatdropped out from study (24% in the placebo group and 26% in the spironolactone group). Could youdetail in numbers the reasons for the drop-outs. In addition, there is some less degree of cardiacfailure in patients taking spironolactone (27% in class IV in the spironolactone group; 31% in class IVhttp://www.journalclub.org/vol2/a72.htmlPage 7 of 8