|
COPYRIGHT 2002 International Medical News Group
Introduction
A message from symposium chair Bertram Pitt, MD, Professor of Internal Medicine at the University of Michigan School of Medicine, Ann Arbor, Michigan.
We have made remarkable strides in our understanding of the role that aldosterone plays in cardiorenal disease, and with that knowledge comes a better understanding of the important role aldosterone receptor antagonists may have in treating a whole host of cardiovascular diseases. I predict we are going to see major changes in treatment practices for several of these conditions in the next decade.
If we look at hypertension, for example, we know that despite having a variety of antihypertensive agents at our disposal, we have not done a very good lob at treating the disease. According to NHANES II data, of the 5 million Americans who have hypertension, 32% are unaware that they even have it, 15% know it but are not receiving treatment, and 26% are being treated but the hypertension remains uncontrolled. Of course, hypertension is a major risk factor in the development and progression of cardiovascular damage. It is clear we need additional therapeutic modalities to improve the picture.
Stroke, one of the more serious consequences of untreated hypertension, represents a tremendous burden to medical care in the Western world. It is the third-leading cause of death in the United States. Obviously, our current therapeutic strategies are not ideal. And although cardiovascular disease in general may be decreasing, heart failure is one of the more rapidly growing disease entities. Some 4.8 million people in the United States have heart failure, and experts predict a two- to threefold increase in prevalence due to the aging of our population. The 5-year survival rate for these patients is 50% [Pharmacotherapy. 2000;5:495].
Despite the fact that we have angiotensin-converting enzyme (ACE) inhibitors and [Beta]-blockers to treat cardiovascular disease, there is tantalizing evidence that an aldosterone receptor antagonist approach will become a significant addition to our arsenal of treatment options. The Randomized Aldactone Evaluation Study has already shown that the nonselective aldosterone receptor antagonist spironolactone was effective in reducing mortality in severe heart failure. There is a tremendous amount of information coming out, however, that makes us believe aldosterone blockers are going to play a role in mild to moderate heart failure, postmyocardial infarction, and a whole spectrum of cardiovascular diseases. The first and only selective aldosterone blocker eplerenone, which has less affinity for androgen and progesterone receptors than spironolactone, is being studied in a clinical trial on patients with acute myocardial infarction complicated by heart failure due to systolic left ventricular dysfunction. In ren al disease, as well, there are indications that adding an aldosterone blocker to on ACE inhibitor may provide added benefit.
A distinguished panel of researchers in the field of aldosterone was assembled on November 10, 2001, in Anaheim, Calif., to review the pathaphysiology, basic understanding, and clinical applications of aldosterone in cardiorenal disease as part of a continuing medical education symposium sponsored by the University of Michigan. Their presentations are summarized in these pages.
Aldosterone: Unanticipated Cardiovascular Role
Medicine now knows more about the effects of aldosterone in the human body than it did just a few years ago. The hormone aldosterone used to be thought of as acting only on the kidneys, causing retention of sodium and fluid. Recent scientific insights have revealed that there are aldosterone receptors not only in the kidneys but also in the brain, blood vessels, and the heart, as well as other organs, and there is now evidence that aldosterone produces injuries...
Read the full article for free courtesy of your local library.
|
Bookmark this article
Print this article
Link to this article
Email this article
Digg It!
Add to del.icio.us
RSS
