Mineralocorticoid receptor antagonists for therapy of coronary artery disease and related complications

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▸ Aldosterone levels predict mortality and/or MACCE in patients with CAD, MI or CHF. ▸ MR activation induces cardiovascular inflammation, endothelial dysfunction and remodelling. ▸ MRAs reduce mortality and hospitalization in patients with reduced LV function, CHF or acute MI. ▸ MRAs are still under-prescribed although prescription is safe under certain precautions.

The perception of aldosterone action to be restricted to regulation of fluid balance via sodium reabsorption and potassium excretion is incomplete; plenty of experimental and clinical studies have shown that aldosterone plays a pivotal role in a variety of (patho-) physiologic conditions within the cardiovascular continuum. Deleterious effects include cardiovascular inflammation, endothelial dysfunction, structural and electrical remodelling. Mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone, prevent some of these maladaptive effects on the cardiovascular system and have proven to be a highly efficacious pharmacological therapy. In this article we review the current clinical impact of MRAs in the treatment of coronary artery disease (CAD) and its related complications, for example, acute myocardial infarction (MI) and chronic heart failure.

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