The effectiveness of mineralocorticoid receptor antagonists (MRAs) in reducing cardiovascular events is significant in patients with and without heart failure (HF), and in atrial fibrillation (AF ) is consistent regardless of its state. european heart journal.

Previous systematic reviews of randomized trials have reported inconsistent results regarding the importance of MRA’s ability to reduce the incidence of AF events, and newly introduced MRAs have Its ability to reduce major cardiovascular events in at-risk patient populations has not been adequately investigated. Therefore, the researchers sought to assess whether heart failure and atrial fibrillation status alter the cardioprotective effects of her MRA.

Researchers will be conducting a study evaluating the effectiveness of MRA versus placebo or usual care in reducing cardiovascular outcomes and atrial fibrillation events in at-risk patients from inception to late March 2023 in Cochrane Central, MEDLINE We conducted a systematic review and meta-analysis searching the , and Embase databases. For or with cardiovascular disease.

Overall, the researchers included 41 randomized controlled trials (RCTs, N=37,159 participants, mean age 64.9 years, 30.4% women) that showed relevant results in the meta-analysis. Eight trials used usual care as a comparator, and 33 trials used a placebo.

In seven RCTs (n=20,741 participants, mean age 65.6 years, 32% women), with a mean follow-up of 33.3 months, researchers found that when MRA was compared with placebo, there was no significant risk of death from cardiovascular disease or heart failure. We found that the composite of hospitalizations due to (risk) ratios was consistently reduced across patients with heart failure. [RR]0.81; 95% CI, 0.67-0.98) and no HF (RR, 0.84; 95% CI, 0.75-0.93; P_{Alternating current} =.77).

In 5 RCTs (n=7003 participants, mean age 66.7 years, 34.3% female), with mean follow-up of 26.3 months, MRA reduced the composite of cardiovascular death or hospitalization for heart failure in patients with heart failure (hazard ratio [HR]0.95; 95% CI, 0.54-1.66) and similarly in patients without AF (HR, 0.82; 95% CI, 0.63-1.07; P_{Alternating current} =.65).

In pooled data from 20 trials (n=21,791 participants, mean age 65.2 years, 31.3% women, median follow-up 29.7 years), MRA reduced AF events in patients with and without AF (RR , 0.76, 95% CI, 0.67-0.87). Month).

Some included studies were at high risk of bias for AF events.

Limitations of systematic reviews and meta-analyses include unavailability of subgroup-level data stratified by AF status, wide range of CIs in AF subgroup analyses, and lack of information on adverse events of MRA. One example is that there are

“Mineralocorticoid receptor antagonists are similarly effective in preventing cardiovascular events in patients with and without HF and are likely to maintain their effectiveness regardless of atrial fibrillation status,” researchers wrote. is writing. “Mineralocorticoid receptor antagonists may be moderately effective in preventing incident or recurrence of atrial fibrillation.” They stated that, unlike other heart failure therapies, the effectiveness of MRA in reducing cardiovascular events is consistent regardless of the presence or absence of AF.

Disclosure: Some study authors declared affiliations with biotechnology, pharmaceutical, and/or device companies. Please see the original bibliography for a complete list of author disclosures.