Cardiometabolic & kidneyRandomised controlled trial
Mineralocorticoid Receptor Antagonism Prevents Aortic Plaque Progression and Reduces Left Ventricular Mass and Fibrosis in Patients With Type 2 Diabetes and Chronic Kidney Disease: The MAGMA Trial
- Randomised controlled trial
- double-blind
- placebo-controlled
Authors' conclusion
Among patients with diabetes with moderate to severe chronic kidney disease at elevated cardiovascular risk, treatment with spironolactone prevented progression of aortic wall volume and resulted in regression of LV mass and favorable alterations in native T1, suggesting amelioration of left-ventricular fibrosis.
Study context
- Population
- High-risk T2DM with CKD (not receiving dialysis) on maximum tolerated renin-angiotensin system blockademodified ITT
- Participants
- 79 participants
- Comparison
- Spironolactone vs placebo
- Spironolactonen = 37
- Placebon = 42reference
- Primary endpoint
- Change in thoracic aortic wall volume, absolute or percent (ΔTWV or ΔPWV), by 3T MRI
- Follow-up
- 12 months
Primary result
As reported in the abstract
| Group | Value | ΔTWV |
|---|---|---|
| Placebo | average change in PWV 7.1 ± 10.7 % | 1.2±1.7 cm3 |
| Spironolactone | average change in PWV 0.87 ± 10.0 % | 0.037±1.9 cm3 |
- Spironolactone vs Placebo: P = 0.028 — PWV
- Spironolactone vs Placebo: P = 0.022 — ΔTWV
Secondary outcomes
| Outcome | Spironolactone | Placebo | P value |
|---|---|---|---|
| Change in LV mass · 12 months | −5.8 ± 8.4 g | 3.1 ± 8.4 g | P = 0.001 |
| Change in LV native T1 (fibrosis) · 12 months | −10.1 ± 36.3 ms | 26.0 ± 41.9 ms | P = 6.33×10-4 |
Mediation analysis
- Spironolactone effect on aortic wall volume and myocardial mass remained significant after adjustment for ambulatory and central BP
Plasma proteomics
- Dominant effect of spironolactone on oxidative stress, inflammation and leukocyte activation pathways
Original publication
Mineralocorticoid Receptor Antagonism Prevents Aortic Plaque Progression and Reduces Left Ventricular Mass and Fibrosis in Patients With Type 2 Diabetes and Chronic Kidney Disease: The MAGMA Trial. Circulation. Published 12 August 2024. doi:10.1161/circulationaha.123.067620
Summarised from the published abstract; every number is checked against it