Endocrine Practice最新文献

{"title":"Effects of continuous glucose monitoring versus blood glucose monitoring during a carbohydrate-restricted nutrition intervention in people with type 2 diabetes: 6-month follow-up outcomes from a randomized clinical trial.","authors":"Holly J Willis, Stephen E Asche, Rebecca N Adams, Caroline G P Roberts, Amy L McKenzie, Shannon Krizka, Shaminie J Athinarayanan, Alison R Zoller, Brittanie M Volk, Richard M Bergenstal","doi":"10.1016/j.eprac.2025.05.746","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.746","url":null,"abstract":"<p><strong>Objectives: </strong>Low and very-low carbohydrate eating patterns can improve glycemia in people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) may also help improve glycemic outcomes, like time in range (TIR). This research evaluated differences in diabetes-related outcomes when people with T2D used CGM or blood glucose monitoring (BGM) to support dietary choices and medication management for six months during a virtual, medically supervised ketogenic diet program (MSKDP). Three-month primary outcomes are published, and here we report six-month follow-up outcomes.</p><p><strong>Methods: </strong>The IGNITE study (Impact of Glucose moNitoring and nutrItion on Time in rangE) randomized participants to use CGM (N=81) or BGM (N=82) to support care during six months in a MSKDP. Glycemia, diabetes medications, dietary intake, ketones, and weight were assessed at baseline (Base) and month 6 (M6); differences between and within arms were evaluated.</p><p><strong>Results: </strong>Adults (N=163) with mean (SD) T2D duration of 9.7 (7.7) years and HbA1c of 8.1% (1.2%) participated. From Base to M6, TIR improved 61% to 87% for CGM and 63% to 88% for BGM (p<0.001), with no difference in changes between arms (p=0.99). HbA1c decreased at least 1.3% from Base to M6 in both arms (p<0.001). Diabetes medications were de-intensified in both arms based on medication effect scores (p<0.01). Energy and carbohydrate intake decreased (p<0.001) and participants in both arms had clinically meaningful weight loss (p<0.001).</p><p><strong>Conclusions: </strong>The CGM and BGM arms achieved similar and significant improvements in glycemia and other diabetes-related outcomes after six months in this MSKDP.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Inpatient Hypoglycemia: A Diversified Approach to a Complex Problem.","authors":"Audrey R Lane, Melissa McKnight, Kaeli Samson, Mitchell N Nohner, Andjela Drincic","doi":"10.1016/j.eprac.2025.05.744","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.744","url":null,"abstract":"<p><strong>Objective: </strong>Hypoglycemia in hospitalized patients is a persistent adverse event. Three quality improvement interventions were implemented with the aim of reducing hypoglycemia. Each intervention was targeted at one component of typical inpatient insulin management (basal, prandial, and correction) to attempt to achieve this singular quality improvement aim.</p><p><strong>Methods: </strong>Incidence of hypoglycemia in non-obstetrics patients ≥ 19 years of age at a tertiary hospital receiving scheduled insulin before and after the implementation of quality improvement initiatives was compared. Incidence was defined as the number of unique patients with a hypoglycemic event in each month, divided by all admissions for that month. The interventions included integrating weight-based insulin guidance into the electronic medical record (EMR), the addition of a carbohydrate-limited diet, and increasing the threshold for correction insulin administration from 150 mg/dL to 180 mg/dL.</p><p><strong>Results: </strong>After implementation of the interventions, there was a significantly lower incidence of hypoglycemia associated with prandial insulin (p = 0.02) and correction insulin (p < 0.001). There was not a significant decrease in hypoglycemia associated with basal insulin in the overall sample (p =0.25). There was a significant decrease in a subgroup analysis focused on hospital-associated hyperglycemia and type 2 diabetes (via exclusion of patients with type 1 diabetes or cystic fibrosis-related diabetes) (p = 0.005). Notably, following the interventions, there was a reduction in institutional blood glucose readings within goal range (71-179 mg/dL), which presumably translates to an increase in hyperglycemia given the known decrease in hypoglycemia (p value <0.0001).</p><p><strong>Conclusion: </strong>Through a multipronged approach consisting of three unique QI interventions - each targeting one aspect of inpatient insulin management - our academic institution was able to significantly reduce the number of inpatient hypoglycemic events.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Diabetes-related Autoantibodies Among Individuals with Type 2 Diabetes from Primary Care and Endocrinology Community Practice Settings.","authors":"Laura D Lomeli, Michelle D Lundholm, Huijun Xiao, Keren Zhou, Kevin M Pantalone","doi":"10.1016/j.eprac.2025.05.748","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.748","url":null,"abstract":"<p><strong>Objective: </strong>The full implications of diabetes-related autoantibodies for classification and management of type 2 diabetes remain undetermined. To date, there are limited data on autoantibody positivity in community-based samples in the United States . This study assessed and compared the prevalence of diabetes-related autoantibodies in a community-based population of individuals with type 2 diabetes managed by endocrinology or primary care providers (PCPs).</p><p><strong>Methods: </strong>This single-center cross-sectional study enrolled 202 adults (102 endocrinology, 100 PCP) with type 2 diabetes without a history of latent autoimmune diabetes of adulthood (LADA). Glutamic acid decarboyxlase-65 (GAD-65), anti-islet cell, insulinoma-associated-2, zinc transporter 8, and anti-insulin antibodies were determined.</p><p><strong>Results: </strong>Among 199 participants with full antibody panel testing results, 13.6% tested positive for at least one diabetes-related autoantibody; prevalence trended higher, but non-significantly, among individuals managed by endocrinologists (16.0%) versus PCPs (11.1%). GAD-65 positivity was 4.5%. No participants displayed anti-islet cell autoantibodies. After excluding an additional 12 individuals positive for only anti-insulin antibodies, 8.0% of the remaining participants were autoantibody-positive (median age, 71 years; median BMI, 31.8 kg/m²).</p><p><strong>Conclusions: </strong>The prevalence of diabetes-related autoantibodies in individuals with type 2 diabetes in a US community-based care setting, most of whom did not display LADA phenotype characteristics, was notable and similar regardless of management by endocrinology or PCP practices. Although further studies are needed to assess the clinical implications of these findings, it is possible that proactive awareness of autoantibody status in individuals with type 2 diabetes could provide additional context to help guide treatment decisions.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging of Adrenal Masses.","authors":"Francis T Delaney, Ryan Chung, Michael A Blake, Ann T Sweeney","doi":"10.1016/j.eprac.2025.05.743","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.743","url":null,"abstract":"<p><p>Adrenal lesions are common and require appropriate management when clinically relevant. The approach to the evaluation of an adrenal lesion is to exclude malignancy and hormone excess as these are associated with significant morbidity and mortality. Imaging of adrenal lesions primarily aims to identify features indicating benignity. Non-contrast CT is recommended as first-line imaging for adrenal lesions. Indeterminate lesions that require further characterization may proceed to adrenal protocol CT (with contrast) or MRI, with a trend in recent years towards increasing use of MRI. PET-CT may also be used to assess adrenal lesions in certain clinical scenarios. Clinical guidelines recommend that all adrenal incidentalomas require further dedicated imaging unless they are clearly benign on imaging. The imaging strategy of adrenal lesions depends upon a number of factors including patient history, nature of detection, imaging characteristics (size, heterogeneity, presence of intracellular lipid), and the presence or absence of hormone excess. Special considerations are given to pregnant patients, young patients < 40 years, and those with a history of an extra-adrenal malignancy. This review outlines the role of imaging for adrenal lesions, describes the various imaging options and investigation strategies, and highlights relevant imaging findings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Diagnosis Frequency and Associated Factors of Non-Alcoholic Fatty Liver Disease among U.S Hospitalized Adults in Urban vs. Rural populations from 2007 - 2019: An Emerging Public Health Crisis\".","authors":"Judy Huynh, Asef Raiyan Hoque, S Sethu K Reddy","doi":"10.1016/j.eprac.2025.05.740","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.740","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and understand differences between U.S. rural and urban populations with respect to outcomes of hospitalization and related epidemiology of Non-alcoholic fatty liver disease (NAFLD).</p><p><strong>Methods: </strong>We analyzed data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2007 to 2019, identifying 847,165 NAFLD cases, of which 370,131 met inclusion criteria. Statistical analyses included Pearson's chi-square, independent samples t-tests, Mann-Whitney U tests, and multivariate logistic regression models to examine factors associated with NAFLD.</p><p><strong>Results: </strong>Hospitalizations due to NAFLD significantly increased over time from 2007 - 2019 with urban cases constituting 84.9% while rural cases represented 15.1%. Differences in demographics, hospital characteristics, insurance, income, and outcomes were significant between the two groups. Multivariate analysis showed higher odds of NAFLD diagnosis in fringe metro areas (adjusted odds ratio [a.O.R.]=1.074, 95% CI=1.044-1.105), medium metro counties ((a.O. R.=1.146, 95% CI=1.114-1.179), small metro counties (a.O. R.=1.182, 95% CI=1.140-1.226), and rural regions (a.O. R.=1.279, 95% CI=1.233-1.327) compared to central metro areas. NAFLD was more prevalent in females, those aged 35-49 or 50-64 years, and White patients, particularly among those with diabetes, metabolic syndrome, and obesity.</p><p><strong>Conclusion: </strong>The increasing prevalence of NAFLD suggests a strong association with metabolic and cardiovascular diseases. With increasing closure of rural hospitals, we may see more rural patients with NAFLD admitted to urban centers. Early detection and diagnosis should help prevent long-term complications of NAFLD.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring for Prediabetes - Roles, Evidence, and Gaps.","authors":"Salwa J Zahalka, Halis K Akturk, Rodolfo J Galindo, Viral N Shah, Cecilia C Low Wang","doi":"10.1016/j.eprac.2025.05.742","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.742","url":null,"abstract":"<p><p>Continuous glucose monitoring (CGM) has transformed the care of patients with diabetes, and there is great potential to extend these benefits to prediabetes. The recent FDA approval of over the counter CGMs has increased interest for use in individuals with prediabetes. It is of particular interest to use CGM to guide early individualized lifestyle interventions to prevent the progression of prediabetes to diabetes and support reversion to normoglycemia. In this review, we discuss published evidence regarding CGM metrics in normoglycemia, briefly review the use of CGM to diagnose prediabetes, and review available evidence for CGM use during lifestyle interventions in individuals with prediabetes. Future studies are needed to validate CGM metrics for prediabetes and evaluate effects of early intervention with CGM in this population.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-hour vs. two-hour postprandial glucose targets and fetomaternal outcomes in gestational diabetes mellitus: A systematic review and meta-analysis.","authors":"Deep Dutta, Saptarshi Bhattacharya, Lakshmi Nagendra, Abm Kamrul Hasan","doi":"10.1016/j.eprac.2025.05.741","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.05.741","url":null,"abstract":"<p><strong>Objective: </strong>The optimal time and target for postprandial glucose (PPG) measurement in gestational diabetes mellitus (GDM) remain unclear. This systematic review and meta-analysis evaluated whether targeting 1-hour PPG (1hPG) vs. 2-hour PPG (2hPG) altered fetomaternal outcomes in GDM.</p><p><strong>Methods: </strong>Studies that compared pregnancy outcomes in women undergoing 1hPG vs. 2hPG monitoring in GDM were identified through comprehensive search of electronic databases. Primary outcomes analyzed were large-for-gestational age (LGA) and macrosomia. Secondary outcomes included low birthweight (LBW), neonatal intensive-care unit (NICU) admission, neonatal hypoglycemia, cesarean section (CS), preeclampsia, gestational age at delivery and preterm delivery.</p><p><strong>Results: </strong>Six articles that compared 1hPG<140mg/dL (7.8mmol/L) vs. 2hPG <120mg/dL (7.2 mmol/L) were analyzed. Additionally, three articles that assessed 1hPG<120mg/dL vs 1hPG<140mg/dL were also examined. Targeting 1hPG<140mg/dL vs. 2hPG<120mg/dL significantly lowered the risk of LGA [OR 0.54; 95%CI:0.32-0.93;P=.03] but not macrosomia [OR 0.45; 95%CI:0.19-1.06;P=.07]. There was no difference in other parameters such as birthweight [MD -61.77g; 95%CI:-152.16-28.62;P=.018], LBW [OR 0.90; 95%CI:0.30-2.68;P=0.85], neonatal hypoglycemia [OR 0.60; 95%CI:0.28-1.26;P=0.18], gestational age at delivery [MD 0.20weeks; 95%CI:-0.29-0.68;P=0.43], CS [OR 0.99; 95%CI:0.46-2.12;P=0.97], preeclampsia [OR 0.66;95% CI:.22-1.96;P=0.46], or need for insulin therapy [OR 1.39; 95%CI:.79-2.43;P=0.25;]. More intensive 1hPG target <120mg/dl vs. <140mg/dl increased the risk of preterm delivery [OR 1.62; 95%CI:1.00-2.62;P=0.05], without affecting birthweight, LGA, macrosomia, LBW, and CS.</p><p><strong>Conclusion: </strong>Our findings suggest that targeting 1hPG <140mg/dL vs. 2hPG<140mg/dL lowers the risk of LGA, but does not affect other parameters. A stricter target of 1hPG<120mg/dL can increase the risk of preterm delivery. Further studies to corroborate these findings are necessary.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Subcutaneous Hydrocortisone Infusion in Adrenal Insufficiency: Practical Experience in 33 Subjects.","authors":"Jane Lee, Oksana Hamidi, Emily Simon, Sasan Mirfakhraee","doi":"10.1016/j.eprac.2025.05.004","DOIUrl":"10.1016/j.eprac.2025.05.004","url":null,"abstract":"<p><strong>Objectives: </strong>Diminished subjective health status and increased mortality have been reported in people with adrenal insufficiency (pwAI) receiving conventional glucocorticoid replacement therapy. Continuous subcutaneous hydrocortisone infusion (CSHI) permits individualized glucocorticoid delivery and mimics a more physiologic cortisol pattern compared with oral glucocorticoid therapy. However, data are limited regarding patient selection for CSHI, optimal dosing of CSHI, and CSHI impact on relevant clinical outcomes.</p><p><strong>Methods: </strong>We performed a single-center, retrospective longitudinal cohort study in 33 consecutive pwAI offered a therapeutic trial of CSHI due to persistent AI symptoms.</p><p><strong>Results: </strong>Our cohort comprised of 33 pwAI (82% women). Nine (27.3%) had primary adrenal insufficiency, 16 (48.5%) had secondary AI, and 8 (24.2%) had glucocorticoid-induced AI. The median total daily dose of glucocorticoid (in hydrocortisone equivalent) decreased from 30 mg/d (range, 15-180 mg) before CSHI to 26.7 mg/d (P = .013) at CSHI initiation and 26.6 mg/d (P = .023) at last encounter. The median number of ED visits/year due to adrenal crisis decreased from 0.5 (range, 0-3.4) to 0 (P = .002) and median number of hospitalization days/y decreased from 0.2 (range, 0-18) to 0 (P = .019) after switching to CSHI. There was a numerical increase in subjective health scores (SF-36 survey) following CSHI use. No significant differences were noted for change in weight, blood pressure, diabetes, cardiovascular/cerebrovascular events, total cholesterol, LDL, and/or triglyceride concentrations pre and post CSHI. At study conclusion, most patients (84.8%) remained on CSHI based on personal preference and tolerability.</p><p><strong>Conclusions: </strong>CSHI is a safe and effective means of delivering individualized glucocorticoid therapy to pwAI.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Fine-Needle Aspiration in Goiter With Compressive Symptoms: A Systematic Review and Meta-analysis.","authors":"Moeen Sbeit, Rania Faris, Ohad Ronen","doi":"10.1016/j.eprac.2025.05.002","DOIUrl":"10.1016/j.eprac.2025.05.002","url":null,"abstract":"<p><strong>Objective: </strong>There are currently no firm recommendations regarding the necessity of preoperative fine-needle aspiration (FNA) in patients with symptomatic goiter. FNA is an efficient and reliable method for determining the risk of malignancy of thyroid nodules; thus, it became the primary procedure for diagnosing neoplasms and guiding surgical treatment. We performed this systematic review of articles to establish the necessity of FNA in patients with compressive goiter.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic literature search was conducted using electronic databases. Included were studies dealing with euthyroid goiter and compressive symptoms in adult patients designated to undergo therapeutic surgery. Two reviewers independently extracted the data and assessed the risk of bias using the risk of bias visualization (ROBVIS; visualization tool). Our main outcome measure was final histology compared with preoperative FNA.</p><p><strong>Results: </strong>The initial search identified 3304 relevant studies. After screening and quality assessment, 14 studies were included in the systematic review. The FNA accuracy of malignant and nonmalignant nodules diagnosed correctly preoperatively was 88.4%. In a meta-analysis that included both benign and malignant preoperative FNA results with subsequent postoperative histology, we observed a relative risk of 0.79.</p><p><strong>Conclusion: </strong>Our data underscore the significant value of preoperative FNA when planning a thyroidectomy for patients with a goiter. The FNA results enable both the physician and the patient to make informed decisions, consider a staged surgical approach if necessary, determine an appropriate follow-up strategy, and discuss potential complications based on the preoperative findings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life-Saving Drug or Potential Threat? The Role of Mineralocorticoid Receptor Antagonists in Myocardial Infarction: A Meta-Analysis.","authors":"Xiangfeng Guan, Ju Zhang, Yang Yu, Chunxiang Zhang","doi":"10.1016/j.eprac.2025.05.001","DOIUrl":"10.1016/j.eprac.2025.05.001","url":null,"abstract":"<p><p>Mineralocorticoid receptor antagonists (MRAs) have been studied as a potential therapeutic option to improve outcomes in patients with myocardial infarction (MI). Although several randomized controlled trials have evaluated the effectiveness of MRAs in post-MI patients, the specific effects remain debated. We systematically searched databases including Web of Science, PubMed, Embase, and Cochrane Library. The primary efficacy outcome was death from any cause. Secondary efficacy outcomes included death from cardiovascular causes, death from MI, and others. Subgroup analyses were performed based on the presence of heart failure and the type of MRA used. Safety outcomes included hyperkalemia, hypokalemia, breast tenderness, and gynecomastia. A total of 13 randomized controlled trials involving 17 851 patients were included. The results demonstrated that MRAs significantly reduced the risk of death from any cause (relative risk [RR] 0.87; 95% CI 0.79-0.95; P = .004). Subgroup analysis indicated that the effectiveness of MRAs varied based on the presence of heart failure. MRAs significantly reduced the risk of death from cardiovascular causes in heart failure patients (RR 0.87; 95% CI 0.78-0.97), but had no significant effect in patients without heart failure (RR 0.69; 95% CI 0.34-1.38). Furthermore, subgroup analysis based on different MRA drugs showed varying effects on outcomes. While some adverse events, such as hyperkalemia (RR 1.95; 95% CI 1.55-2.46; P < .01), were significantly more frequent, other safety events did not show significant differences. MRAs improve cardiovascular outcomes in MI patients, especially in those with heart failure. When choosing a specific MRA drug, eplerenone or spironolactone is recommended.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}