Abstract 3916: Effect of Eplerenone Versus Spironolactone on Adiponectin and Hemoglobin A1c Levels in Patients With Chronic Heart Failure
Background. Adiponectin has important metabolic effects including insulin sensitivity and plasma adiponectin level is elevated in patients with chronic heart failure (CHF). Hemoglobin A1c (HbA1c) level is reported to be an independent risk factor for mortality in CHRAM study population, suggesting the important role of insulin resistance in CHF.
Methods and Results. To compare the metabolic effect of a selective mineralocorticoid receptor blocker eplerenone with spironolactone in patients with CHF, 84 stable outpatients of CHF who received standard therapy such as ACE-I or ARB and b blockers, were randomized (1:2) to spironolactone (25mg/day) or eplerenone (50mg/day). We measured plasma levels of brain natriuretic peptide (BNP), adiponectin, HbA1c and cortisol were determined before and 4 months after either spironolactone or eplerenone. There was no difference in the baseline characteristics including hemodynamics and plasma levels of biomarkers between two groups. In both groups, plasma BNP levels were significantly decreased and plasma aldosterone levels were significantly increased after 4 months. In patients receiving spironolactone (n=29), plasma adiponectin was significantly decreased (14.5±9.1 vs. 11.8±8.4 ug/mL, p=0.0004) and HbA1c was significantly increased (5.6±0.6 vs. 5.9±0.7 %, p<0.001), and cortisol was significantly increased (11.6±4.8 vs. 14.3±4.5 ug/dL, p<0.05). In patients receiving spironolactone, there was a significant correlation between the changes of cortisol and the changes of HbA1c (r=0.454, p=0.013) and there was no correlation between the changes of adiponectin and the changes of HbA1c. In contrast, in patents receiving eplerenone (n=55) plasma adiponectin did not change (14.5±9.5 vs. 13.9±9.8 ug/mL, p=0.201) and HbA1c did not change (5.6±0.6 vs. 5.6±0.7 %, p=0.854), and cortisol did not change (12.3±4.6 vs. 13.2±4.5 ug/dL, p=0.131).
Conclusion. These findings indicate that the metabolic effects of eplerenone are different from those of spironolactone and that a selective mineralocorticoid receptor blocker eplerenone is superior to spironolactone in metabolic effects in patients with CHF.