Nuove evidenze sull'impiego degli antialdosteronici nella disfunzione ventricolare sinistra: Spironolattone ed eplerenone. Dal postinfarto allo scompenso cardiaco

Translated title of the contribution: New evidence on the use of aldosterone antagonists in left ventricular dysfunction: Spironolactone and eplerenone. From post-infarction to heart failure

Cesare Greco, Gabriele Castelli, Filippo Crea, Antonello Gavazzi, Gian Franco Gensini, Marino Scherillo, Gianfranco Sinagra

Research output: Contribution to journalArticle


Heart failure and myocardial infarction result in considerable consumption of healthcare resources. Therefore, there is interest in the availability of drug therapies that can favorably modify their prognosis in the post-acute phase, reducing mortality and rehospitalization rates. Aldosterone antagonists represent a class of drugs which offer advantages in these settings, in addition to those obtained with beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, even though attention should be drawn to their potential adverse effects. In particular, eplerenone exhibits a better safety profile than spironolactone. Since it has very little affinity for glucocorticoid, androgen and progesterone receptors, eplerenone has less antiandrogenic and progestagenic effects, resulting in a lower incidence of gynecomastia. The EPHESUS study showed that eplerenone can reduce mortality in the short and long term and the rate of new hospitalizations after a myocardial infarction complicated by heart failure. In addition, in the EMPHASIS-HF study eplerenone reduced cardiovascular mortality and hospitalizations after mild heart failure (NYHA class IIa). Despite these important results, which confirmed those obtained with spironolactone in severe heart failure in the RALES study, aldosterone antagonists are still underutilized. In particular, eplerenone is not yet available in Italy, although it is recommended by the latest European Society of Cardiology guidelines.

Original languageItalian
Pages (from-to)809-816
Number of pages8
JournalGiornale Italiano di Cardiologia
Issue number12
Publication statusPublished - Dec 2012


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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