Sparing a little may save a lot: lessons from the Studies of Left Ventricular Dysfunction (SOLVD).

Over the past 20 years, attention to the renin-angiotensinaldosterone system has brought marked success in the treatment of heart failure (HF). With the publication of the Randomized Aldactone Evaluation Study (RALES) trial, spironolactone became another cornerstone of therapy for the treatment of patients with New York Heart Association (NYHA) functional class III to IV HF (1). Based on the studied benefits of spironolactone, some practices have extended the use of spironolactone to other patients with less severe HF. However, a recent study cautioned against liberalizing the use of spironolactone to patients outside the RALES study (2), and current professional guidelines recommend spironolactone for patients with NYHA functional class III/IV HF only when added to angiotensinconverting enzyme (ACE) inhibitor and beta-blocker therapy (3,4). The study by Domanski et al. (5) in this issue of the Journal provides more information about the impact of