The Role of Mineralocorticoid Receptor Antagonists in Patients with American College of Cardiology/American Heart Association Stage B Heart Failure

Background: Heart failure (HF) is a worldwide modern epidemic, associated with significant morbidity and mortality. Several causes have been identified for the syndrome, most of which share common pathophysiologic pathways, including neurohormonal activation. Central to the latter lies activation of the reninangiotensin- aldosterone system, and its effects on cardiovascular disease progression. Objectives: The aim of this review is to summarize the pathophysiology of aldosterone and the effects of its blockage in the failing heart, as well as to provide state-of-the-art evidence, and address future perspectives regarding the use of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction. Method: Literature was reviewed for studies that assess the pathophysiology of aldosterone in HF with reduced ejection fraction (HFrEF), and the effects of mineralocorticoid receptor antagonists (MRAs) in this condition. Results: Several major society guidelines have synthesized the available evidence on HFrEF management, and drugs that block the renin-angiotensin-aldosterone system at different levels continue to form the key component of standard of care for these patients. Mineralocorticoid receptor antagonists are an important part of HFrEF pharmacologic treatment, and their use is supported by a high level of evidence studies. This class of drugs demonstrated significant benefits for morbidity and mortality, across the spectrum oh HFrEF, including patients after acute myocardial infarction. Conclusion: Current evidence supports the central role of aldosterone in HFrEF progression, and the significant benefits on outcomes with the use of MRAs.

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Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000490 ◽

2017 ◽

Vol 135 (22) ◽

Cited By ~ 172

Author(s):

Sheryl L. Chow ◽

Alan S. Maisel ◽

Inder Anand ◽

Biykem Bozkurt ◽

Rudolf A. de Boer ◽

...

Keyword(s):

Heart Failure ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Scientific Statement

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Effect of Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction and with Reduced Ejection Fraction - A Narrative Review

Current Vascular Pharmacology ◽

10.2174/1570161119666210720120439 ◽

2021 ◽

Vol 19 ◽

Author(s):

Adriana Mares ◽

Tayana Rodriguez ◽

Abhizith Deoker ◽

Angelica Lehker ◽

Debabrata Mukherjee

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Mineralocorticoid Receptor ◽

Narrative Review ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Reduced Ejection Fraction

Background: Heart failure is a major cause of morbidity and mortality globally. By end of this decade, ~8 million Americans will have heart failure, with an expenditure of $69.8 billion. Objective: In this narrative review, we evaluate the benefits, potential risks, and role of Mineralocorticoid Receptor Antagonists (MRAs) in the management of both Heart Failure with Preserved Ejection Fraction (HFpEF) and Heart Failure with Reduced Ejection Fraction (HFrEF). Methods: We performed a comprehensive literature review to assess the available evidence on the role of MRAs in heart failure using the online databases (PubMed, Embase, Scopus, CINAHL, and Google Scholar). Results: Clinical evidence shows that MRAs, such as spironolactone and eplerenone, reduce mortality and readmissions for patients with HFrEF compared with placebo. Furthermore, one trial has reported that MRAs minimize heart failure hospitalization in patients with HFpEF. The American College of Cardiology/American Heart Association Guidelines strongly recommend using MRA in patients with reduced left ventricular ejection fraction (LVEF) with Class II-IV symptoms, estimated glomerular filtration rate >30 ml/min/1.73 m2, and absence of hyperkalemia. Despite this, MRAs are underutilized in the management of heart failure. Conclusions: MRAs improve outcomes in patients with both HFpEF and HFrEF but remain underutilized.

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