Vizzardi Enrico, Regazzoni Valentina, Caretta Giorgio, Gavazzoni Mara, Sciatti Edoardo, Bonadei Ivano, Trichaki Eleftheria, Raddino Riccardo, Metra Marco
Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
Int J Cardiol Heart Vessel. 2014 Mar 19;3:6-14. doi: 10.1016/j.ijchv.2014.03.005. eCollection 2014 Jun.
Aldosterone is involved in various deleterious effects on the cardiovascular system, including sodium and fluid retention, myocardial fibrosis, vascular stiffening, endothelial dysfunction, catecholamine release and stimulation of cardiac arrhythmias. Therefore, aldosterone receptor blockade may have several potential benefits in patients with cardiovascular disease. Mineralocorticoid receptor antagonists (MRAs) have been shown to prevent many of the maladaptive effects of aldosterone, in particular among patients with heart failure (HF). Randomized controlled trials have demonstrated efficacy of MRA in heart failure with reduced ejection fraction, both in patients with NYHA functional classes III and IV and in asymptomatic and mildly symptomatic patients (NYHA classes I and II). Recent data in patients with heart failure with preserved ejection fraction are encouraging. MRA could also have anti-arrhythmic effects on atrial and ventricular arrhythmias and may be helpful in patient ischemic heart disease through prevention of myocardial fibrosis and vascular damage. This article aims to discuss the pathophysiological effects of aldosterone in patients with cardiovascular disease and to review the current data that support the use of MRA in heart failure.
醛固酮对心血管系统有多种有害影响，包括钠和液体潴留、心肌纤维化、血管硬化、内皮功能障碍、儿茶酚胺释放以及刺激心律失常。因此，醛固酮受体阻断在心血管疾病患者中可能有多种潜在益处。盐皮质激素受体拮抗剂（MRAs）已被证明可预防醛固酮的许多不良适应性影响，尤其是在心力衰竭（HF）患者中。随机对照试验已证明MRAs在射血分数降低的心力衰竭患者中有效，无论是纽约心脏协会（NYHA）功能分级为III级和IV级的患者，还是无症状和轻度症状患者（NYHA I级和II级）。近期关于射血分数保留的心力衰竭患者的数据令人鼓舞。MRAs对房性和室性心律失常也可能有抗心律失常作用，并且通过预防心肌纤维化和血管损伤，可能对缺血性心脏病患者有帮助。本文旨在讨论醛固酮在心血管疾病患者中的病理生理作用，并综述支持在心力衰竭中使用MRAs的现有数据。
