Mineralocorticoid receptor antagonists in heart failure: a systematic review and meta-analysis

作者：Yue Zhang, Yong Bao, Lixia Wang, Hongjuan Zhao, Jing Sun, Lin Sun, Wei Duan, Ming Du, L. Wang, Qin-Yan An, Wen-Ze Yang · 发表于：Frontiers in Cardiovascular Medicine · 年份：2025 · DOI：10.3389/fcvm.2025.1667236 · 被引用次数：5 · 研究领域：Hormonal Regulation and Hypertension、Heart Failure Treatment and Management、Adrenal Hormones and Disorders

Background Mineralocorticoid receptor over-activation drives maladaptive myocardial fibrosis, vascular inflammation and renal sodium retention across the entire spectrum of left ventricular ejection fraction (LVEF). While steroidal MRAs have convincingly reduced hospitalizations and mortality in patients with heart failure and reduced EF (HFrEF), evidence remains fragmented for heart failure with mildly reduced (HFmrEF) or preserved EF (HFpEF), and no head-to-head data distinguish steroidal from non-steroidal agents. This study aimed to evaluate the effect of MRAs in patients with HF across the range of ejection fraction. Methods Searched PubMed, Web of Science, Wanfang and Cochrane library (1 Jan 1987–10 Sep 2024) for randomized clinical trials (RCT) assessing MRAs (finerenone, spironolactone, eplerenone) in HFpEF, HFmrEF or HF. The primary endpoint was composite cardiovascular (CV) outcomes. Secondary endpoints included CV mortality, overall HF exacerbation events, safety, and adverse events. A meta-analysis was conducted using hazard ratios (HR), confidence intervals (CI), and relative risks (RR) to synthesize the findings. Results In the analysis of nine RCTs, MRAs were associated with a 23% reduction in CV composite outcomes (RR: 0.77, 95% CI: 0.72–0.83, P < 0.00001), a 23% reduction in HF hospitalization risk (HR: 0.77, 95% CI: 0.70–0.84, P < 0.00001), and a 22% reduction in all-cause mortality (HR: 0.78, 95% CI: 0.72–0.85, P < 0.00001) in HFrEF pat...