Clinical InvestigationCongestive Heart FailureEffect of eplerenone versus spironolactone on cortisol and hemoglobin A1c levels in patients with chronic heart failure
Section snippets
Patients
The study subjects were 107 stable outpatients with mild CHF (NYHA class I or II) who had already been receiving standard therapy for >6 months. Patients with CHF were defined as patients who had previously been admitted to hospital for management of CHF due to systolic heart failure, which was defined as left ventricular ejection fraction (LVEF) <45% by 2-dimensional echocardiography or ventriculography using contrast medium or radioisotope, or had already been receiving treatment for CHF
Baseline clinical characteristics
There was no difference in baseline hemodynamic parameters including LVEF between the 2 groups (Table I). At entry into the study, most patients were receiving ACEI or ARB and β-blockers. There were no significant differences in the proportion of CHF patients with diabetes mellitus (DM) (P = .35) or the distribution of anti-diabetic therapies including diet therapy between the 2 groups (P = .76). Further, hydrophilic statin was mainly used for lipid lowering therapy and there was no difference
Discussion
In this study, we demonstrated for the first time that treatment with spironolactone for 4 months increased plasma HbA1c levels and serum cortisol levels in patients with CHF, while treatment with eplerenone did not. Furthermore, Δincrease in plasma HbA1c levels was positively correlated with Δincrease in cortisol levels after treatment with spironolactone. These findings suggest that eplerenone may be more useful than spironolactone for the treatment of CHF patients with DM, who easily
Conclusions
These findings indicated that a selective MR blocker eplerenone was superior to spironolactone due to differences in metabolic effects especially those on HbA1c in CHF patients. Compared with spironolactone, eplerenone may be more useful for treatment of CHF patients from the perspective of insulin resistance and cortisol levels, which were related to poor prognosis.
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