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(Circulation. 2007;115:2976-2982.)
© 2007 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Should aldosterone antagonists be considered as primary therapy for prevention of sudden cardiac death?

Added Benefit of Mineralocorticoid Receptor Blockade in the Primary Prevention of Sudden Cardiac Death

Bertram Pitt, MD; Geoffrey S. Pitt, MD, PhD

From the University of Michigan School of Medicine, Ann Arbor (B.P.); and Departments of Pharmacology and Medicine, Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY (G.S.P).

Correspondence to Bertram Pitt, MD, University of Michigan School of Medicine, Division of Cardiology, University Hospital, 1500 East Medical Center Dr, Ann Arbor, MI 48109–0366. E-mail bpitt@umich.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Sudden cardiac death (SCD) is a major public health issue. In patients with heart failure (HF) of various origins, including ischemia post-myocardial infarction (MI), successful development of pharmacological therapies that target neurohormonal abnormalities and modulate disease progression has changed the major cause of death from progressive pump failure to SCD from cardiac arrhythmias. Conditions such as hypertension, hypertrophic cardiomyopathy, aortic stenosis, diabetes mellitus, and aging are accompanied by hypertrophy and fibrosis, increasing the risk of SCD. Also affected are patients with inherited arrhythmogenic disorders such as long-QT syndrome and Brugada syndrome (BrS). Although the mechanisms responsible for SCD, its epidemiology, and treatment have recently been reviewed,^1–4 1 aspect of therapy that deserves further emphasis for the prevention of SCD is the role of aldosterone blockade (AB) or, more precisely, mineralocorticoid receptor blockade (MRB).

Response by Kloner and Cannom p 2982

As with any pharmacological approach to reduce SCD, including MRB, implantable cardioverter-defibrillators (ICDs) and/or cardiac resynchronization therapy (CRT) will remain central in the secondary prevention of SCD in high-risk individuals. Rather, we hypothesize that MRB may have an important role in the primary prevention of SCD in high-risk individuals both with and without systolic left ventricular dysfunction (SLVD) and as an adjunct to ICDs and/or CRT, both in the primary and secondary prevention of SCD. In this article, we will briefly review the current experience with MRB in the prevention of SCD in patients with severe chronic HF and SLVD and in patients with SLVD and HF post-MI. We will . . . [Full Text of this Article]

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