Mineralocorticoid Antagonism in Heart Failure: Established and Emerging Therapeutic Role.

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-09-01 DOI:10.1016/j.jchf.2024.08.007

Joycie Chang, Andrew P Ambrosy, Orly Vardeny, Harriette G C Van Spall, Robert J Mentz, Andrew J Sauer

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Abstract

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.

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矿物质皮质激素拮抗剂在心力衰竭中的作用：已确立和新出现的治疗作用。

心力衰竭（HF）的病理生理学与矿物皮质激素受体的过度激活有关，导致体液潴留和不良的心肌重塑。尽管矿物质皮质激素受体拮抗剂（MRAs）被推荐用于治疗射血分数降低的心力衰竭（HFrEF），但由于高钾血症等不良反应，MRAs仍未得到充分利用；而且其对射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）的疗效也存在争议。最近在糖尿病和肾病患者中进行的试验支持使用非甾体类 MRAs 降低与心力衰竭相关的发病率和死亡率，其副作用也少于类固醇类药物。非甾体类 MRA 尚未在心房颤动中进行疗效和安全性测试，目前正在其他临床试验中进行评估。本综述全面研究了目前有关 MRA 治疗高血压的数据以及非甾体类 MRA 研究的未来方向，同时探讨了 MRA 未得到充分利用的原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.