Finerenone, glycaemic status, and heart failure with mildly reduced or preserved ejection fraction: A prespecified analysis of the FINEARTS-HF trial

IF 10.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Heart Failure Pub Date : 2025-04-10 DOI:10.1002/ejhf.3649

Jawad H. Butt, Pardeep S. Jhund, Alasdair D. Henderson, Brian L. Claggett, Akshay S. Desai, Carolyn S.P. Lam, Meike Brinker, Patrick Schloemer, Prabhakar Viswanathan, Andrea Lage, Katja Rohwedder, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Muthiah Vaduganathan, Scott D. Solomon, John J.V. McMurray

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Abstract

Aims

The efficacy and safety of the non-steroidal mineralocorticoid receptor antagonist, finerenone, have not been examined in patients without diabetes. We examined the efficacy and safety of finerenone, compared with placebo, according to glycaemic status in FINEARTS-HF.

Methods and results

A total of 6001 patients with heart failure (HF) with New York Heart Association functional class II–IV, left ventricular ejection fraction ≥40%, evidence of structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide levels were randomized to finerenone or placebo. The effect of finerenone according to glycaemic status (i.e. normoglycaemia [no investigator-reported history of diabetes and glycated haemoglobin (HbA1c) <5.7%], pre-diabetes [no investigator-reported history of diabetes and HbA1c 5.7–6.4%] and diabetes [investigator-reported history of diabetes or HbA1c ≥6.5%]) at baseline were examined. The primary outcome was cardiovascular death and total worsening HF events. At baseline, 1243 (20.8%) patients were normoglycaemic, 1979 (33.1%) had pre-diabetes, and 2764 (46.2%) had diabetes. Compared with patients with normoglycaemia, those with diabetes, but not pre-diabetes, had a higher rate of the primary endpoint (normoglycaemia: reference; pre-diabetes: adjusted rate ratio [RR] 1.02, 95% confidence interval [CI] 0.84–1.23; diabetes: adjusted RR 1.32 [95% CI 1.11–1.58]). The benefit of finerenone on the primary outcome was consistent across glycaemic status (normoglycaemia: RR 0.85 [95% CI 0.63–1.14]; pre-diabetes: RR 0.85 [95% CI 0.66–1.08]; diabetes: RR 0.82 [95% CI 0.69–0.98]; p_interaction = 0.93). The effects of finerenone on the components of the primary outcome, all-cause death, composite kidney endpoints, and improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score were not modified by glycaemic status.

Conclusion

In patients with HF with mildly reduced/preserved ejection fraction, the beneficial effects of finerenone, compared with placebo, on clinical events and symptoms, were consistent, irrespective of glycaemic status at baseline.

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芬烯酮、血糖状态和心力衰竭伴射血分数轻度降低或保留：FINEARTS-HF试验的预先分析

非甾体类矿化皮质激素受体拮抗剂非格列酮（fineerenone）的疗效和安全性尚未在非糖尿病患者中进行过研究。我们根据 FINEARTS-HF 中的血糖状况，研究了非奈瑞酮与安慰剂相比的疗效和安全性。

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来源期刊

European Journal of Heart Failure 医学-心血管系统

CiteScore

27.30

自引率

11.50%

发文量

365

审稿时长

1 months

期刊介绍： European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.