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http://dx.doi.org/10.1016/j.mayocp.2024.11.009 | DOI Listing |
JACC Heart Fail
August 2025
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA. Electronic address:
Steroidal mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone, have demonstrated substantial benefits in randomized controlled trials for patients with heart failure with reduced ejection fraction. However, their effectiveness in heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction remains uncertain, and the implementation of this class has remained low, in part due to its side effects and tolerability profile. Emerging therapies that target the mineralocorticoid receptor and/or the production of aldosterone may offer alternative strategies to treat the aldosterone-mineralocorticoid receptor axis.
View Article and Find Full Text PDFHeart Fail Rev
August 2025
Duke Clinical Research Institute, Durham, NC, USA.
Hyperkalemia is a potentially life-threatening electrolyte imbalance that has traditionally posed significant challenges in the management of heart failure (HF). This review explores the complex interplay between hyperkalemia and the use of guideline-directed medical therapies (GDMT), such as renin-angiotensin-aldosterone system inhibitors (RAASi) and steroidal mineralocorticoid receptor antagonists (sMRAs), including spironolactone and eplerenone, which are currently recommended in guidelines for improving outcomes in heart failure with reduced ejection fraction (HFrEF). While these therapies reduce mortality and hospitalizations in HFrEF, their benefit in patients with heart failure with left ventricular ejection fraction (LVEF) ≥ 40% remains less conclusive.
View Article and Find Full Text PDFCureus
July 2025
Department of Diabetes and Endocrinology, Khartoum North Teaching Hospital, Khartoum, SDN.
Finerenone is a novel third-generation nonsteroidal mineralocorticoid receptor antagonist (MRA) that has demonstrated efficacy in treating chronic kidney disease (CKD) and heart failure with reduced ejection fraction (HFrEF). Unlike traditional steroidal MRAs such as Spironolactone and Eplerenone, Finerenone offers high selectivity for MR, resulting in reduced off-target effects, including hyperkalemia and antiandrogenic side effects. It exerts renoprotective and cardioprotective effects through its anti-inflammatory and antifibrotic actions, making it a good therapeutic option for patients with CKD and HFrEF.
View Article and Find Full Text PDFCardiovasc Ther
August 2025
Department of Cardiology, Shenzhen Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong, China.
Atrial autonomic nerve system (ANS) remodeling plays an important role in atrial fibrillation (AF). Mineralocorticoid receptor antagonists (MRAs) have been proved to be effective in preventing atrial structural remodeling. However, the effects of MRA on ANS remodeling in AF and the underlying mechanisms are still unknown.
View Article and Find Full Text PDFEur J Endocrinol
July 2025
Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain.
Objective: This study aims to analyze current medical management of primary aldosteronism (PA) in Spain, including doses, adverse events (AEs), and efficacy.
Methods: SPAIN-ALDO is a national, multicenter, retrospective registry of patients with PA in Spain. For this study, information about medical treatment with mineralocorticoid receptor antagonist (MRA) as first-line or postsurgical therapy and about antihypertensive medications used before PA targeted treatment (MRA or adrenalectomy) was included.