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Spironolactone improved myocardial abnormalities in patients with metabolic syndrome

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Use of spironolactone in combination with ACE inhibitors or angiotensin receptor blockers showed a decrease in fibrotic markers in patients with metabolic syndrome, according to study results.

Before entering the study, patients with metabolic syndrome had to be on ACE inhibitors or angiotensin receptor blockers for at least 6 months. Overall, 80 patients (mean age, 59 years) were randomly assigned to spironolactone (Pfizer) 25 mg per day or placebo for 6 months.

Primary endpoint included systolic echocardiographic and diastolic parameter assessment of alterations in left ventricular function. For secondary endpoints, procollagen type I carboxy-terminal propeptide (PICP) and procollagen type III amino-terminal propeptide (PIIINP) serum levels assessed change in collagen metabolism. Integrated backscatter, LV wall thickness and LV mass estimated myocardial echodensity.

Researchers found improvement in LV function, myocardial reflectivity and LV hypertrophy among patients in the spironolactone group, as well as a parallel decrease in PICP and PIIINP levels. However, the placebo group showed no analogous changes. Improvement in LV systolic function was associated with baseline strain (beta=0.47; P<.0001), spironolactone therapy (beta=–0.38; P<.0001) and change in PICP level (beta=–0.19; P<.03), according to the results. Baseline early diastolic mitral annular velocity (beta=0.47; P<.0001), spironolactone therapy (beta=–0.21; P<.03), change in PICP level (beta=–0.23; P<.02) and age (beta=0.22; P,.04) were correlated with improvement of LV diastolic function.

Overall, this study provides evidence for beneficial effects of aldosterone blockade in patients with metabolic syndrome, according to Dominic Y. Leung, MBBS, PhD, of the department of cardiology at Liverpool Hospital, New South Whales, Australia. Along with hypertensive heart disease, chronic kidney disease and HF with preserved systolic function, Leung wrote in an accompanying editorial that metabolic syndrome “is certainly another target for more comprehensive blockade of the reninangiotensin-aldosterone system.

“Given the increasing prevalence of metabolic syndrome, the inability to adopt sufficient lifestyle modifications and the significant morbidities and mortality associated with the condition, the medical community is in need of potentially ‘disease modifying’ therapies such as aldosterone blockade,” Leung said.

For more information:

• Kosmala W. J Am Coll Cardiol Img. 2011;4:1239-1249.
• Leung DY. J Am Coll Cardiol Img. 2011;4:1250-1252.

Disclosure: The researchers report no relevant financial disclosures.

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