Reducing Cardiovascular Risk in Patients following MI with Eplerenone

Background: In the event of an MI, the presence of LV systolic dysfunction with or without heart failure is associated with a poorer prognosis. Elevation of aldosterone levels also results in a poor prognosis after an MI. Objective: This review discusses the cardiovascular benefits of blocking the aldosterone receptor using eplerenone therapy in post MI patients. Methods: A literature search of Pubmed was conducted for relevant English language articles published between 1990–2010 using the search terms eplerenone, aldosterone, myocardial infarction, heart failure and endothelial dysfunction. Additional articles were obtained from reference lists of identified publications. Results: Eplerenone is a selective aldosterone receptor blocker that has been shown by a landmark study, EPHESUS to reduce all cause mortality, cardiovascular mortality and heart failure admissions in post MI patients with LV systolic dysfunction and heart failure or diabetes. It blocks the damaging effects of aldosterone including LV remodeling, endothelial dysfunction and arrhythmogenicity. Due to its selective action, there are less sexual side effects compared with spironolactone therapy. However, a small risk of hyperkalemia and renal dysfunction is associated with eplerenone therapy. Conclusions: Eplerenone therapy should be commenced for post MI patients with LV systolic dysfunction and heart failure or diabetes provided there are no contraindications.