在患有心力衰竭和功能受损的患者中,矿物甲基皮质类受体对手
Shingo Matsumoto1, Alasdair D Henderson1, Li Shen1
1British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
Journal of the American College of Cardiology
|May 13, 2024
概括
矿物质皮质类受体抗剂 (MRAs) 有效地减少心血管死亡和心力衰竭住院治疗的患者减少喷射分数,即使功能下降. 由于显著的绝对风险降低,这种下降不应该停止MRA治疗.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 功能障碍常常会阻碍启动或延续基本心力衰竭 (HF) 治疗.
- 患有减少喷射分数 (HFrEF) 的HF患者经常表现出功能受损.
研究的目的:
- 评估矿物质皮质类受体对抗剂 (MRA) 在具有显著功能障碍的HFrEF患者的疗效和安全性.
- 为了确定下降的估计膜过率 (eGFR) 是否会影响MRA的有效性.
主要方法:
- 汇集了来自RALES和EMPHASIS-HF试验的个人患者数据.
- 基于eGFR的评估MRA治疗结果下降到<30 mL/min/1.73 m2.
- 主要结局:心血管死亡或HF住院治疗.
主要成果:
- 在4355名患者中,6.8%的患者经历了EGFR下降到<30mL/min/1.73m2.
- 患有eGFR下降的患者对于主要结局的基线风险更高.
- 不管eGFR下降 (P相互作用 = 0.87),MRA疗法对于主要结局表现出类似的风险降低.
结论:
- 具有eGFR<30mL/min/1.73m2的患者面临非常高的心血管风险.
- 在这个高风险群体中,MRAs的绝对风险降低是相当大的.
- 降低EGFR不应成为停止MRA治疗的自动原因.
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