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Exploring the potential synergistic action of spironolactone on nitric oxide-enhancing therapy: insights from the African-American Heart Failure Trial.
J Card Fail. 2008 Nov; 14(9):718-23.JC

Abstract

BACKGROUND

To investigate if treatment with an aldosterone antagonist affects the outcomes of treatment by fixed dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo in black heart failure (HF) patients treated with contemporary HF medications. In the African-American Heart Failure Trial (A-HeFT), FDC I/H was effective in reducing mortality and improving event-free survival. The beneficial effects of aldosterone antagonist (spironolactone [SP]), however have not been adequately assessed in black patients with or without the use of FDC I/H.

METHODS AND RESULTS

A retrospective analysis was performed in A-HeFT data base (n = 1050) to determine the effect of using SP (39% of patients) on outcomes. Baseline comparisons were done by 2-sample t-test or Fisher's exact test. Kaplan-Meier survival analyses were used for comparing between and within groups for outcomes. SP had no effect on mortality, event-free survival, or first HF hospitalization in the overall A-HeFT population. However, SP decreased mortality risk in the FDC I/H group by 59% (P = .03), and a favorable trend was noted on event-free survival and first HF hospitalization. In contrast, the use of SP was not associated with a decrease in mortality or HF hospitalizations in the placebo group.

CONCLUSIONS

This study suggests that in black patients with systolic heart failure on standard therapy of beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, the beneficial effects of aldosterone antagonists require a background therapy of FDC I/H.

Authors+Show Affiliations

Wayne State University, Detroit, MI 48201, USA. jghali@med.wayne.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18995175

Citation

Ghali, Jalal K., et al. "Exploring the Potential Synergistic Action of Spironolactone On Nitric Oxide-enhancing Therapy: Insights From the African-American Heart Failure Trial." Journal of Cardiac Failure, vol. 14, no. 9, 2008, pp. 718-23.
Ghali JK, Tam SW, Sabolinski ML, et al. Exploring the potential synergistic action of spironolactone on nitric oxide-enhancing therapy: insights from the African-American Heart Failure Trial. J Card Fail. 2008;14(9):718-23.
Ghali, J. K., Tam, S. W., Sabolinski, M. L., Taylor, A. L., Lindenfeld, J., Cohn, J. N., & Worcel, M. (2008). Exploring the potential synergistic action of spironolactone on nitric oxide-enhancing therapy: insights from the African-American Heart Failure Trial. Journal of Cardiac Failure, 14(9), 718-23. https://doi.org/10.1016/j.cardfail.2008.07.189
Ghali JK, et al. Exploring the Potential Synergistic Action of Spironolactone On Nitric Oxide-enhancing Therapy: Insights From the African-American Heart Failure Trial. J Card Fail. 2008;14(9):718-23. PubMed PMID: 18995175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exploring the potential synergistic action of spironolactone on nitric oxide-enhancing therapy: insights from the African-American Heart Failure Trial. AU - Ghali,Jalal K, AU - Tam,S William, AU - Sabolinski,Michael L, AU - Taylor,Anne L, AU - Lindenfeld,Joann, AU - Cohn,Jay N, AU - Worcel,Manuel, Y1 - 2008/08/09/ PY - 2008/04/16/received PY - 2008/06/26/revised PY - 2008/07/02/accepted PY - 2008/11/11/pubmed PY - 2009/6/9/medline PY - 2008/11/11/entrez SP - 718 EP - 23 JF - Journal of cardiac failure JO - J. Card. Fail. VL - 14 IS - 9 N2 - BACKGROUND: To investigate if treatment with an aldosterone antagonist affects the outcomes of treatment by fixed dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo in black heart failure (HF) patients treated with contemporary HF medications. In the African-American Heart Failure Trial (A-HeFT), FDC I/H was effective in reducing mortality and improving event-free survival. The beneficial effects of aldosterone antagonist (spironolactone [SP]), however have not been adequately assessed in black patients with or without the use of FDC I/H. METHODS AND RESULTS: A retrospective analysis was performed in A-HeFT data base (n = 1050) to determine the effect of using SP (39% of patients) on outcomes. Baseline comparisons were done by 2-sample t-test or Fisher's exact test. Kaplan-Meier survival analyses were used for comparing between and within groups for outcomes. SP had no effect on mortality, event-free survival, or first HF hospitalization in the overall A-HeFT population. However, SP decreased mortality risk in the FDC I/H group by 59% (P = .03), and a favorable trend was noted on event-free survival and first HF hospitalization. In contrast, the use of SP was not associated with a decrease in mortality or HF hospitalizations in the placebo group. CONCLUSIONS: This study suggests that in black patients with systolic heart failure on standard therapy of beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, the beneficial effects of aldosterone antagonists require a background therapy of FDC I/H. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/18995175/Exploring_the_potential_synergistic_action_of_spironolactone_on_nitric_oxide_enhancing_therapy:_insights_from_the_African_American_Heart_Failure_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1071-9164(08)00637-4 DB - PRIME DP - Unbound Medicine ER -