Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction

作者：Jawad H. Butt, Alasdair D Henderson, Pardeep S. Jhund, Brian Claggett, Akshay S. Desai, James Lay‐Flurrie, Prabhakar Viswanathan, Andrea Lage, Markus F. Scheerer, Carolyn S.P. Lam, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Johann Bauersachs, Cândida Fonseca, Mikhail Kosiborod, Gerard C.M. Linssen, Mark C. Petrie, Morten Schou, Subodh Verma, Faı̈ez Zannad, Bertram Pitt, Muthiah Vaduganathan, Scott D. Solomon, John J.V. McMurray · 发表于：Journal of the American College of Cardiology · 年份：2024 · DOI：10.1016/j.jacc.2024.10.111 · 被引用次数：47 · 研究领域：Hormonal Regulation and Hypertension、Heart Failure Treatment and Management、Cardiovascular Function and Risk Factors

Obesity is associated with excessive adipocyte-derived aldosterone secretion, independent of the classical renin-angiotensin-aldosterone cascade, and mineralocorticoid receptor antagonists may be more effective in patients with heart failure (HF) and obesity. This study sought to examine the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone compared with placebo, according to body mass index (BMI) in FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure). A total of 6,001 patients with HF with NYHA functional class II, III, and IV, a left ventricular ejection fraction of ≥40%, evidence of structural heart disease, and elevated natriuretic peptide levels were randomized to finerenone or placebo. BMI (kg/m 2 ) was examined using World Health Organization categories, namely, underweight/normal weight (<25.0 kg/m 2 ; n = 1,306); overweight (25.0-29.9 kg/m 2 ; n = 1,990); obesity class I (30.0-34.9 kg/m 2 ; n = 1,546); obesity class II (35.0-39.9 kg/m 2 ; n = 751); and obesity class III (≥40 kg/m 2 ; n = 395). The primary outcome was cardiovascular death and total worsening HF events. Data on baseline BMI were available for 5,988 patients (median: 29.2 kg/m 2 ; Q1-Q3: 25.5-33.6 kg/m 2 ). Compared with patients who were underweight/normal weight, those with obesity class II or III had a higher risk of the primary outcome (underweight/normal weight, reference; overweight, unadjusted rate ratio: ...