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Vai trò của các chất đối kháng receptor mineralocorticoid (MRAs) ở những bệnh nhân cao tuổi bị suy tim
Tóm tắt
Các chất đối kháng receptor mineralocorticoid (MRAs) đã chứng tỏ hiệu quả trong việc giảm tỷ lệ tử vong tổng quát ở bệnh nhân suy tim (HF) và có tỉ lệ phân suất tống máu thất trái giảm. Do phát hiện rằng nồng độ aldosterone giảm theo tuổi tác, một câu hỏi đặt ra là hiệu quả của MRAs ở những bệnh nhân rất cao tuổi (≥80 tuổi), nhóm có nguy cơ cao nhất phát triển suy tim với phân suất tống máu thất trái bảo tồn (PEF). Tuy nhiên, mặc dù nồng độ aldosterone giảm theo tuổi, cũng có sự giảm nồng độ enzyme 11 beta HSD2 theo tuổi, do đó cho phép cortisol kích thích receptor mineralocorticoid (MR), trong khi ở những bệnh nhân trẻ hơn có nồng độ 11 beta HSD2 cao hơn thì cortisol được chuyển đổi thành cortisone, không có khả năng kích hoạt MR. Cũng có sự gia tăng trong việc biểu hiện MR ở thành mạch theo tuổi. Do đó, có lý do để tin rằng MRAs có thể hiệu quả trong việc giảm tỷ lệ tử vong tim mạch và tỷ lệ nhập viện vì suy tim ở những bệnh nhân rất cao tuổi bị HFPEF. Cũng có lý do để tin rằng MRAs có thể ảnh hưởng tích cực đến nhiều điều kiện kết hợp liên quan đến HFPEF ở những bệnh nhân rất cao tuổi. Tính an toàn và hiệu quả của giả thuyết này hiện đang được nghiên cứu trong thử nghiệm TOPCAT do NHLBI tài trợ.
Từ khóa
#suy tim #đối kháng receptor mineralocorticoid #aldosterone #bệnh nhân cao tuổi #tỷ lệ tử vong tim mạchTài liệu tham khảo
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