Mineralocorticoid Antagonism in Heart Failure Established and Emerging Therapeutic Role

被引：8
作者：
Chang, Joycie [1 ,2 ]
Ambrosy, Andrew P. [3 ]
Vardeny, Orly [4 ]
Van Spall, Harriette G. C. [5 ]
Mentz, Robert J.
Sauer, Andrew J. [1 ,2 ]
机构：
[1] St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64111 USA
[2] Univ Missouri, Kansas City Sch Med, Kansas City, MO USA
[3] Kaiser Permanente San Francisco Med Ctr, Dept Cardiol, San Francisco, CA USA
[4] Minneapolis VA Ctr Care Delivery & Outcomes Res, Minneapolis, MN USA
[5] McMaster Univ, Fac Hlth Sci, Hamilton, ON, Canada
来源：
JACC-HEART FAILURE | 2024年 / 12卷 / 12期
关键词：
heart failure; mineralocorticoid receptor antagonist; PRESERVED EJECTION FRACTION; RECEPTOR ANTAGONISTS; SECONDARY ANALYSIS; KIDNEY-DISEASE; SPIRONOLACTONE; OUTCOMES; FINERENONE; TOPCAT; HYPERKALEMIA;
D O I：
10.1016/j.jchf.2024.08.007
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization. (c) 2024 by the American College of Cardiology Foundation.
引用
收藏
页码：1979 / 1993
页数：15
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