According to findings from the ASPIRE (Aliskiren Study in Post-MI Patients to Reduce Remodelling) trial, adding the direct renin inhibitor aliskiren to standard medical therapy does not prevent left ventricular remodelling after myocardial infarction (MI). These data were presented at the American College of Cardiology scientific meeting.

The study included 820 patients who had an MI ≤ 6 weeks prior to enrolment and an ejection fraction of ≤45%.  They were randomised to receive either aliskiren (initiated at 75mg/day and increased to 300mg/day within two weeks) or placebo, in addition to ‘the best available medical therapy’ (including an ACEI or ARB).  

Interpretable baseline and follow-up echocardiograms were available for 672 subjects.  At 36 weeks, left ventricular end-systolic volume was reduced by an average of 4.4mL with aliskiren and 3.5mL with placebo (p=NS). There were no significant differences between the two groups in the extent to which end-diastolic volume or ejection fraction changed over time, or in the rates of the composite endpoint of cardiovascular death, hospitalisation for heart failure, recurrent myocardial infarction, stroke, or resuscitation from cardiac arrest.

In terms of safety, a higher incidence of hyperkalaemia, hypotension, and kidney dysfunction was seen in the group randomised to aliskiren [no further details are provided in the Reuters report].  The researcher presenting the data commented that “given these results, we are not currently recommending the use of this agent in addition to other inhibitors of the renin-angiotensin system in this specific patient population."