Heart failure & cardiomyopathiesSecondary analysis
Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction
- Secondary analysis of the FINEARTS-HF randomised trial
- subgroup analysis by baseline body mass index (BMI)
Authors' conclusion
In patients with HF with mildly reduced/preserved ejection fraction, the beneficial effects of finerenone on clinical events and symptoms were consistent, irrespective of BMI at baseline, possibly with a greater effect on the primary outcome in patients with higher BMI.
Study context
- Population
- Heart failure (HF), NYHA II–IV, LVEF ≥40%, structural heart disease and elevated natriuretic peptides; BMI by WHO categoriesBMI available for 5,988
- Participants
- 6,001 participants
- Comparison
- Finerenone vs placebo by baseline BMI category
- Primary endpoint
- CV death and total worsening HF events
Primary result
As reported in the abstract
CV death and total worsening HF events, finerenone vs placebo by baseline BMI
Finerenone vs PlaceboRate ratio (95% CI)
underweight/normal weight (<25.0 kg/m²; n = 1,306)
0.80(0.62–1.04)
overweight (25.0-29.9 kg/m²; n = 1,990)
0.91(0.72–1.15)
obesity class I (30.0-34.9 kg/m²; n = 1,546)
0.92(0.72–1.19)
obesity class II-III
0.67(0.50–0.89)
- Effect did not vary by baseline BMI category
- P for interaction = 0.32
- BMI as continuous variable: greater benefit with higher BMI
- P for interaction = 0.005
Further findings
| Outcome | unadjusted rate ratio (95% CI) | |
|---|---|---|
| Primary outcome risk by BMI category (unadjusted, vs underweight/normal weight) — Overweight vs Underweight/normal weight | 0.96 (0.81–1.15) | |
| Primary outcome risk by BMI category (unadjusted, vs underweight/normal weight) — Obesity class I vs Underweight/normal weight | 1.04 (0.86–1.26) | |
| Primary outcome risk by BMI category (unadjusted, vs underweight/normal weight) — Obesity class II-III vs Underweight/normal weight | 1.26 (1.03–1.54) | |
| 0.512Unadjusted rate ratio (log scale) |
Total worsening HF events by BMI
- Similar pattern to primary outcome
CV death, all-cause death, KCCQ improvement by BMI
- Consistent effects across baseline BMI
Original publication
Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction. J Am Coll Cardiol. Published 10 December 2024. doi:10.1016/j.jacc.2024.10.111
Summarised from the published abstract; every number is checked against it