Mineralocorticoid Receptor Antagonists and Mortality in Heart Failure With Concurrent Atrial Fibrillation

Abstract

Aldosterone is the major mineralocorticoid in the human body and is produced in the zona glomerulosa of the cortex in the adrenal glands, and its secretion is stimulated by angiotensin II, adrenocorticotrophic hormone, catecholamines, and local potassium levels. Its levels in plasma are elevated 4-fold in heart failure (HF).1 Through a variety of mechanisms, aldosterone is believed to play a role in the pathogenesis and progression of left ventricular dysfunction.2 The mineralocorticoid receptor antagonists (MRAs) spironolactone and eplerenone have consistently demonstrated a 20% reduction in mortality and 21% reduction in sudden death, which has been counterbalanced by a 6% to 12% risk of hyperkalemia (potassium >6.0 mEq/L) depending on the baseline estimated glomerular filtration rate.3,4,5 Article see p 586 In this issue of Circulation: Heart Failure , O’Meara and colleagues report on a retrospective analysis from …