Author + information
- Orly Vardeny,
- Larisa H. Cavallari,
- Brian Claggett,
- Inderjit Anand,
- Akshay Desai,
- Patrick Rossignol,
- Faiez Zannad,
- Bertram Pitt and
- Scott Solomon
The incidence of hyperkalemia due to mineralocorticoid receptor antagonists (MRAs) may vary by race, but whether race influences efficacy of MRAs is unknown.
We assessed hyperkalemia and efficacy in African Americans (AA, N=120) and non-African Americans (non-AA N=1543; Caucasian 93%) with NYHA class III or IV HF and LV dysfunction randomized to spironolactone (SP) 25mg qday or placebo (PL) in the Randomized Aldactone Evaluation Study (RALES).
Potassium increased in non-AA (4.29±0.5 to 4.55±0.49mEq/L), but not in AAs (4.32±0.54 to 4.31±0.49mEq/L) receiving SP (p < 0.001; race × treatment interaction, p=0.009) in first month and throughout the trial. Compared to AA, non-AA had higher rates of hyperkalemia (K >5.5, 9.7% vs. 4.2%, p<0.046), and lower rates of hypokalemia (K < 3.5, 5.6% vs. 17.9%, p < 0.001). Non-AA were more likely to attain maximal dose (21% vs. 9%, p = 0.04). SP reduced the combined endpoint of death or hospitalization for HF in non-AA (HR 0.63, 95% CI 0.55-0.73), but not in AA (HR 1.07, 95% CI 0.67-1.71; p-interaction=0.038), even when adjusting for covariates that differed between groups (age, sex, diabetes, hypertension, and study dose achieved).
African Americans exhibited less hyperkalemia and more hypokalemia with SP compared to non-African Americans, and appeared to derive less clinical benefit. Although the numbers of AA were small, these hypothesis generating findings suggest that safety and efficacy of MRAs may differ by race.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Heart Failure: Innovations in Medical Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1133M-269
- 2013 American College of Cardiology Foundation