Heart failure & cardiomyopathiesMeta-analysis
Mineralocorticoid-receptor Antagonists (MRAs) and Race in Heart Failure: An Individual Participant Data Meta-Analysis of Randomized Trials
- post hoc individual participant data meta-analysis
- 4 large placebo-controlled trials
Authors' conclusion
There was no statistically significant evidence of heterogeneity in the absolute or relative effects of MRAs on clinical outcomes between Black and non-Black patients with HF, regardless of HF phenotype.
Study context
- Population
- Patients with heart failure (HF) with reduced ejection fraction or HF with mildly reduced/preserved ejection fraction, by self-reported race (Black or non-Black)patients randomized in the 4 trials, 577 (4.2%) identified as Black · Black 577
- Participants
- 13,846 patients
- Comparison
- MRAs versus placebo, according to self-reported race
- Outcome
- Composite of:
- Cardiovascular death
- First HF hospitalization
Pooled result
As reported in the abstract
MRA vs placeboHazard ratio (95% CI)
Black patients; 3.9 fewer events per 100 person-years of treatment
0.87(0.66–1.15)
non-Black patients; 2.7 fewer events per 100 person-years of treatment
0.77(0.72–0.82)
Further pooled results
| Outcome | hazard ratio (95% CI) | |
|---|---|---|
| First HF hospitalization — MRA vs placebo · Black patients | 0.86 (0.63–1.17) | |
| First HF hospitalization — MRA vs placebo · non-Black patients | 0.73 (0.68–0.80) | |
| Cardiovascular death — MRA vs placebo · Black patients | 0.75 (0.48–1.17) | |
| Cardiovascular death — MRA vs placebo · non-Black patients | 0.81 (0.74–0.90) | |
| 0.512Hazard ratio (log scale) |
- First HF hospitalization: P interaction =0.36
- Cardiovascular death: P interaction =0.80
Patient characteristics and event rates, Black vs non-Black
- Age, Black versus non-Black (years)
- 64 versus 70
- Rates of HF hospitalizations and death higher in Black than non-Black patients
Effects by HF phenotype
- Effects of MRAs in HF with reduced ejection fraction and HF with preserved ejection fraction, individually, were not modified by race
Original publication
MRAs and Race in Heart Failure: An Individual Participant Data Meta-Analysis of Randomized Trials. Circ Heart Fail. Published 7 August 2026. doi:10.1161/circheartfailure.125.014355
Summarised from the published abstract; every number is checked against it