Abstract:
OBJECTIVES:We sought to determine whether the addition of spironolactone to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) improves left ventricular mass and arterial stiffness in early-stage chronic kidney disease (CKD). BACKGROUND:Chronic kidney disease is associated with a high risk of cardiovascular disease and a high prevalence of left ventricular hypertrophy and arterial stiffness that confer an adverse prognosis. It is believed that these abnormalities are in part a result of activation of the renin-angiotensin-aldosterone system. METHODS:After an active run-in phase with spironolactone 25 mg once daily, 112 patients with stage 2 and 3 CKD with good blood pressure control (mean daytime ambulatory blood pressure <130/85 mm Hg) on established treatment with ACE inhibitors or ARBs were randomized to continue spironolactone or to receive a matching placebo. Left ventricular mass (cardiac magnetic resonance) and arterial stiffness (pulse wave velocity/analysis, aortic distensibility) were measured before run in and after 40 weeks of treatment. RESULTS:Compared with placebo, the use of spironolactone resulted in significant improvements in left ventricular mass (-14 +/- 13 g vs. +3 +/- 11 g, p < 0.01), pulse wave velocity (-0.8 +/- 1.0 m/s vs. -0.1 +/- 0.9 m/s, p < 0.01), augmentation index (-5.2 +/- 6.1% vs. -1.4 +/- 5.9%, p < 0.05), and aortic distensibility (0.69 +/- 0.86 x 10(-3) mm Hg vs. 0.04 +/- 1.04 x 10(-3) mm Hg, p < 0.01). CONCLUSIONS:The use of spironolactone reduces left ventricular mass and improves arterial stiffness in early-stage CKD. These effects suggest that aldosterone exerts adverse cardiovascular effects in CKD and that spironolactone is worthy of further study as a treatment that could reduce adverse cardiovascular events. (Is Spironolactone Safe and Effective in the Treatment of Cardiovascular Disease in Mild Chronic Renal Failure; NCT00291720).
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Edwards NC,Steeds RP,Stewart PM,Ferro CJ,Townend JNdoi
10.1016/j.jacc.2009.03.066subject
Has Abstractpub_date
2009-08-04 00:00:00pages
505-12issue
6eissn
0735-1097issn
1558-3597pii
S0735-1097(09)01646-5journal_volume
54pub_type
杂志文章,随机对照试验abstract:OBJECTIVES:To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels. BACKGROUND:The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified b...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00434-9
更新日期:1999-11-15 00:00:00
abstract::Sixty patients with recurrent inducible sustained ventricular tachycardia were prospectively treated with nadolol (40 or 80 mg/day). Old myocardial infarction was present in 43 patients and dilated cardiomyopathy in 12. In group I (n = 36), nadolol was given alone, whereas in group II (n = 24), previously ineffective ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90594-f
更新日期:1990-08-01 00:00:00
abstract:OBJECTIVES:This study sought to evaluate the efficacy and safety of torcetrapib in patients with low high-density lipoprotein cholesterol (HDL-C) levels receiving background atorvastatin. BACKGROUND:Elevating HDL-C levels may reduce the residual cardiovascular risk that is observed in patients treated with statin ther...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2006.06.066
更新日期:2006-11-07 00:00:00
abstract:OBJECTIVES:The objective of this study was to evaluate the effects of different lesion sets of ablation in patients undergoing mitral surgery plus maze. BACKGROUND:The role of lesion sets on outcome after maze is poorly defined. METHODS:A total of 141 patients were prospectively followed up. Two different lesion sets...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2010.09.055
更新日期:2011-02-22 00:00:00
abstract:BACKGROUND:Clinical practice guidelines recommend post-operative dual antiplatelet therapy (DAPT) in patients who undergo coronary artery bypass grafting (CABG) following acute coronary syndromes (ACS). OBJECTIVES:The authors have evaluated DAPT utilization rates and associated outcomes among post-CABG patients with d...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2016.10.043
更新日期:2017-01-17 00:00:00
abstract:BACKGROUND:Diabetes confers an increased risk for atherosclerotic cardiovascular disease, but less is known about the independent risk diabetes confers on major cardiovascular and limb events in patients with symptomatic peripheral artery disease (PAD) on contemporary management. OBJECTIVES:The authors sought to asses...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2018.09.078
更新日期:2018-12-25 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the prevalence, characteristics and the predictive value of nonsustained ventricular tachycardia (VT) for subsequent death and arrhythmic events after acute myocardial infarction (AMI). BACKGROUND:Nonsustained VT has been linked to an increased risk for sudden deat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00108-4
更新日期:1999-06-01 00:00:00
abstract::Recent experimental studies show that the opioid system is important to the pathophysiology of cardiovascular impairment in congestive heart failure. Plasma beta-endorphin levels were measured in 37 patients with congestive heart failure and compared with those of 21 age- and gender-matched normal subjects. The relati...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90703-c
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the survival of patients with hypertrophic cardiomyopathy (HCM) after resuscitated ventricular fibrillation or syncopal sustained ventricular tachycardia (VT/VF) when treated with low dose amiodarone or implantable cardioverter defibrillators (ICDs). BACKGROUND:Prospect...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00056-x
更新日期:1999-05-01 00:00:00
abstract::Long-term variation in the frequency of myocardial ischemia during daily activity in patients with coronary artery disease who do not experience symptomatic changes has not been documented. Because at one point in time, the magnitude of such ischemia is strongly related to the ischemic threshold measured during exerci...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80261-x
更新日期:1992-03-01 00:00:00
abstract::Ventricular arrhythmia (VA) in structurally normal hearts can be broadly considered under non-life-threatening monomorphic and life-threatening polymorphic rhythms. Monomorphic VA is classified on the basis of site of origin in the heart, and the most common areas are the ventricular outflow tracts and left ventricula...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2012.01.036
更新日期:2012-05-15 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine whether small reference diameter of the culprit coronary artery influences the outcome of an attempted percutaneous revascularization procedure in the current era of interventional cardiology. BACKGROUND:Although the interventional strategy is largely determined by...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00181-3
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVES:This was a prospective, randomized, controlled study designed to determine the effect of resistance exercise training on bone metabolism in heart transplant recipients. BACKGROUND:Osteoporosis frequently complicates heart transplantation. No preventative strategy is generally accepted for glucocorticoid-ind...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(96)00347-6
更新日期:1996-11-15 00:00:00
abstract::Thirteen patients with tuberculous pericarditis (12 men and 1 woman aged 13 to 70 years [mean 41]) were identified in a group of 294 patients consecutively admitted for primary acute pericardial disease. The diagnosis was made by the following studies: sputum culture (n = 4), culture of pericardial fluid obtained by p...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90203-3
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVES:The goal of this study was to learn more about the risk factors and short- and long-term outcomes for primary angioplasty. BACKGROUND:Primary angioplasty (direct angioplasty without antecedent thrombolytic therapy) has been an effective alternative to thrombolytic therapy for patients with acute myocardial ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/s0735-1097(00)00866-4
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:We sought to compare the effects on angiogenesis and left ventricular (LV) function of adenoviral vascular endothelial growth factor-165 (AdVEGF-165) gene delivery by direct injection of AdVEGF-165 to the transplantation of skeletal myoblasts (SKMB) transfected with AdVEGF-165 in a rat model of ischemic card...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.12.045
更新日期:2004-05-19 00:00:00
abstract::Percutaneous transluminal coronary angioplasty was attempted without streptokinase in 24 patients with total coronary artery occlusion but without acute transmural myocardial infarction. The maximal duration of occlusion was estimated to be 1 week or less in 10 patients, more than 1 to 4 weeks in 6, more than 4 to 12 ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(84)80263-6
更新日期:1984-03-01 00:00:00
abstract:BACKGROUND:Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. OBJECTIVES:This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HO...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2016.07.735
更新日期:2016-10-04 00:00:00
abstract::Cardiovascular disease is the leading cause of mortality in the world, and the increasing burden is largely a consequence of modifiable behavioral risk factors that interact with genomics and the environment. Continuous cardiovascular health promotion and disease prevention throughout the lifespan is critical, and the...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2016.01.036
更新日期:2016-04-12 00:00:00
abstract:OBJECTIVES:We tested the hypothesis that spatial association of low-amplitude intracardiac electrograms can identify the presence, location and extent of dysplastic regions in arrhythmogenic right ventricular dysplasia (ARVD). BACKGROUND:Arrhythmogenic right ventricular dysplasia is a right ventricular (RV) cardiomyop...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01625-4
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVES:This study sought to determine the association between markers of cardiomyocyte injury in ambulatory subjects and sudden cardiac death (SCD). BACKGROUND:The pathophysiology of SCD is complex but is believed to be associated with an abnormal cardiac substrate in most cases. The association between biomarkers...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.07.049
更新日期:2013-12-03 00:00:00
abstract::The effect of atrial pacing on intracoronary thromboxane production was investigated in 35 patients with stable (n = 19) or unstable (n = 16) angina. Arterial and coronary sinus thromboxane B2, the stable metabolite of thromboxane A2, myocardial lactate extraction and thermodilution coronary sinus flow were measured b...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80129-6
更新日期:1983-05-01 00:00:00
abstract::Sudden death in healthy athletes is uncommon but, when it occurs, the primary mechanism is cardiovascular. The major cause of sudden death in the young athlete is hypertrophic cardiomyopathy or related conditions characterized by left ventricular hypertrophy, aortic rupture due to cystic medial necrosis and congenital...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/s0735-1097(86)80285-6
更新日期:1986-01-01 00:00:00
abstract::To understand and promote vascular health, we must reduce the aggression to the vessel wall and enhance the physiologic mechanisms leading to restoration of vessel wall function. Three main defense mechanisms are responsible for maintaining cardiovascular homeostasis: the regenerative production of endothelial progeni...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2009.02.057
更新日期:2009-06-23 00:00:00
abstract:OBJECTIVES:We tested the hypothesis that enalaprilat induces preconditioning (PC)-mimetic actions in patients with stable coronary artery disease. BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors increase the bioavailability of bradykinin, which induces cardiac PC. METHODS:Twenty-two patients undergoing coro...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2007.01.060
更新日期:2007-04-17 00:00:00
abstract:OBJECTIVES:This study was designed to investigate the mutual effects of chronic atrial dilation and electrical remodeling on the characteristics of atrial fibrillation (AF). BACKGROUND:Both electrical remodeling and atrial dilation promote the inducibility and perpetuation of AF. METHODS:In seven goats AF was induced...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.09.041
更新日期:2006-02-07 00:00:00
abstract:OBJECTIVES:We tested the hypothesis of whether an inhibition of the nitroglycerin (GTN) bioactivating enzyme mitochondrial aldehyde dehydrogenase (ALDH-2) contributes to GTN tolerance in human blood vessels. BACKGROUND:The hemodynamic effects of GTN are rapidly blunted by the development of tolerance, a phenomenon ass...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.08.031
更新日期:2007-12-04 00:00:00
abstract:OBJECTIVES:We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome. BACKGROUND:Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial lea...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01964-2
更新日期:2002-07-17 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate more closely the true in-hospital costs of elective revascularization by directional coronary atherectomy and intracoronary stenting and to compare these costs with those of the traditional revascularization alternatives (i.e., conventional balloon angioplasty and coronary...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90415-w
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Major disparities between women and men in the diagnosis, management, and outcomes of acute coronary syndrome are well recognized. OBJECTIVES:The aim of this study was to evaluate the impact of implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial in...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2019.07.082
更新日期:2019-10-22 00:00:00