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Mineralocorticoid receptor antagonist in heart failure: Past, present and future perspectives

Enrico Vizzardi1, Valentina Regazzoni1, Giorgio Caretta1

  • 1Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.

International Journal of Cardiology. Heart & Vessels
|February 17, 2018
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) mitigate aldosterone's harmful cardiovascular effects, offering significant benefits for heart failure patients. Clinical trials confirm MRA efficacy in various heart failure stages and types.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Aldosterone contributes to detrimental cardiovascular outcomes, including fluid retention, fibrosis, and arrhythmias.
  • Mineralocorticoid receptor antagonists (MRAs) counteract aldosterone's adverse effects.

Purpose of the Study:

  • To discuss the pathophysiological roles of aldosterone in cardiovascular disease.
  • To review evidence supporting MRA use in heart failure management.

Main Methods:

  • Review of randomized controlled trials and clinical data on MRA efficacy.
  • Analysis of aldosterone's impact on cardiovascular structures and function.

Main Results:

  • MRAs demonstrate efficacy in heart failure with reduced ejection fraction (HFrEF) across NYHA classes.
  • Emerging data suggest MRA benefits in heart failure with preserved ejection fraction (HFpEF).
  • MRAs show potential anti-arrhythmic effects and cardioprotective benefits in ischemic heart disease.

Conclusions:

  • Aldosterone receptor blockade with MRAs is a valuable therapeutic strategy in cardiovascular disease.
  • MRAs are proven beneficial in HFrEF and show promise in HFpEF and ischemic conditions.

Keywords:
AldosteroneGuidelinesHeart failureMineralocorticoid receptor antagonistsPrognosis

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