Heart failure & cardiomyopathies
Investigating the Efficacy of Mineralocorticoid Receptor Antagonists for Cardiovascular Outcomes in Different Diseases
Authors' conclusion
MRAs exhibit varying cardiovascular protective effects depending on the disease context. These findings support tailored treatment strategies based on specific disease conditions to optimize patient outcomes. Further research with larger and more diverse datasets is needed to validate these results and inform clinical decision-making.
Study context
- Population
- Participants receiving MRA treatment or control, in heart failure, non-HF, diabetes mellitus and chronic kidney disease/end-stage renal disease populations21 investigations
- Participants
- 61,076 participants
- Comparison
- Different mineralocorticoid receptor antagonists (MRAs) versus control for major adverse cardiovascular events (MACE) across disease conditions
Methodological detailsfour literature databases searched, surface under the cumulative ranking curve values calculated, sensitivity analyses
- Four literature databases searched
- Surface under the cumulative ranking curve values calculated
- Sensitivity analyses
Primary result
As reported in the abstract
MACE in heart failure (HF) patients
Each group vs controlHazard ratio (95% CI)
Finerenone
0.68(0.47–0.95)
Spironolactone
0.72(0.55–0.89)
Eplerenone
0.81(0.64–1.10)
Further findings
| Outcome | HR | |
|---|---|---|
| MACE in non-HF populations — spironolactone vs control | 0.40 (95% CI 0.15–1.10) | |
| MACE in non-HF populations — eplerenone vs control | 0.58 (95% CI 0.25–1.30) | |
| MACE in non-HF populations — finerenone vs control | 0.89 (95% CI 0.50–1.60) | |
| MACE in diabetes mellitus population — spironolactone vs control | 0.57 (95% CI 0.13–2.43) | |
| MACE in diabetes mellitus population — finerenone vs control | 0.74 (95% CI 0.41–1.25) | |
| MACE in diabetes mellitus population — eplerenone vs control | 0.78 (95% CI 0.40–1.62) | |
| MACE in chronic kidney disease/end-stage renal disease population (primary analysis) — eplerenone vs control | 0.62 (95% CI 0.32–1.20) | |
| MACE in chronic kidney disease/end-stage renal disease population (primary analysis) — spironolactone vs control | 0.79 (95% CI 0.49–1.06) | |
| MACE in chronic kidney disease/end-stage renal disease population (primary analysis) — finerenone vs control | 0.87 (95% CI 0.55–1.35) | |
| MACE in chronic kidney disease/end-stage renal disease population (sensitivity analysis) — spironolactone vs control | 0.40 (CI 0.15–1.10) | |
| MACE in chronic kidney disease/end-stage renal disease population (sensitivity analysis) — eplerenone vs control | 0.62 (CI 0.27–1.40) | |
| MACE in chronic kidney disease/end-stage renal disease population (sensitivity analysis) — finerenone vs control | 0.87 (CI 0.49–1.50) | |
| 0.10.31310Hazard ratio (log scale) |
- MACE in diabetes mellitus population: Sensitivity analyses which excluded observational studies and included only RCTs showed consistent results for these disease populations
Original publication
Investigating the Efficacy of Mineralocorticoid Receptor Antagonists for Cardiovascular Outcomes in Different Diseases. ESC Heart Fail. Published 14 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it