Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction
IntroductionTo clarify the efficacy of mineralocorticoid receptor antagonists (MRA) and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) in heart failure with mildly reduced ejection fraction (HFmrEF).MethodsThis study assessed the association between these...
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Frontiers Media S.A.
2024-12-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1507326/full |
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| author | Chia-Chen Lee David Te-Wei Kuan Kai-Chun Chang Zheng-Wei Chen Zheng-Wei Chen Jen-Fang Cheng Jen-Fang Cheng Ting-Tse Lin Ting-Tse Lin Lian-Yu Lin Lian-Yu Lin Cho-Kai Wu Cho-Kai Wu |
| author_facet | Chia-Chen Lee David Te-Wei Kuan Kai-Chun Chang Zheng-Wei Chen Zheng-Wei Chen Jen-Fang Cheng Jen-Fang Cheng Ting-Tse Lin Ting-Tse Lin Lian-Yu Lin Lian-Yu Lin Cho-Kai Wu Cho-Kai Wu |
| author_sort | Chia-Chen Lee |
| collection | DOAJ |
| description | IntroductionTo clarify the efficacy of mineralocorticoid receptor antagonists (MRA) and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) in heart failure with mildly reduced ejection fraction (HFmrEF).MethodsThis study assessed the association between these medications and outcomes in HFmrEF using data from the National Taiwan University Hospital-integrated Medical Database. The primary outcome was cardiovascular mortality/heart failure hospitalization (HHF). Inverse probability of treatment weighting balanced baseline patient characteristics. The exposure of primary interest was use of MRA and use of RASI/ARNI, while the non-user group was also likely to receive other heart failure medication treatment.ResultsAmong 2,584 HFmrEF patients, 17% received MRA and 43% received RASI/ARNI. Predictors of MRA use included older age, slightly higher ejection fraction, and lower NT-proBNP level. RASI/ARNI use was predicted by higher BMI, lower NT-proBNP level, normal uric acid and potassium levels. MRA use was not associated with a lower risk of cardiovascular death [hazard ratio = 0.89, 95% confidence interval (CI): 0.78–1.02] or HHF (hazard ratio = 1.01, 95% CI: 0.94–1.09). Conversely, RASI//ARNI use was linked to a lower risk of cardiovascular death (hazard ratio = 0.82, 95% CI: 0.71–0.94) but not HHF (hazard ratio = 0.995, 95% CI: 0.924–1.07). Landmark analysis showed no significant difference in outcomes for follow-up durations exceeding 2 years.ConclusionMRA had a neutral effect on cardiovascular death and HHF, while RASI/ARNI was associated with a lower risk of cardiovascular death. RASI/ARNI may be more beneficial than MRA for HFmrEF patients. Regular re-evaluation is essential to adjust heart failure treatment. |
| format | Article |
| id | doaj-art-db549260384d413fa973c31d7f2e6fa2 |
| institution | OA Journals |
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| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-db549260384d413fa973c31d7f2e6fa22025-08-20T02:38:15ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122024-12-011510.3389/fphar.2024.15073261507326Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fractionChia-Chen Lee0David Te-Wei Kuan1Kai-Chun Chang2Zheng-Wei Chen3Zheng-Wei Chen4Jen-Fang Cheng5Jen-Fang Cheng6Ting-Tse Lin7Ting-Tse Lin8Lian-Yu Lin9Lian-Yu Lin10Cho-Kai Wu11Cho-Kai Wu12Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Yunlin Branch, Yunlin, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TaiwanDepartment of Internal Medicine, College of Medicine, National Taiwan University, Taipei, TaiwanDivision of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TaiwanIntroductionTo clarify the efficacy of mineralocorticoid receptor antagonists (MRA) and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) in heart failure with mildly reduced ejection fraction (HFmrEF).MethodsThis study assessed the association between these medications and outcomes in HFmrEF using data from the National Taiwan University Hospital-integrated Medical Database. The primary outcome was cardiovascular mortality/heart failure hospitalization (HHF). Inverse probability of treatment weighting balanced baseline patient characteristics. The exposure of primary interest was use of MRA and use of RASI/ARNI, while the non-user group was also likely to receive other heart failure medication treatment.ResultsAmong 2,584 HFmrEF patients, 17% received MRA and 43% received RASI/ARNI. Predictors of MRA use included older age, slightly higher ejection fraction, and lower NT-proBNP level. RASI/ARNI use was predicted by higher BMI, lower NT-proBNP level, normal uric acid and potassium levels. MRA use was not associated with a lower risk of cardiovascular death [hazard ratio = 0.89, 95% confidence interval (CI): 0.78–1.02] or HHF (hazard ratio = 1.01, 95% CI: 0.94–1.09). Conversely, RASI//ARNI use was linked to a lower risk of cardiovascular death (hazard ratio = 0.82, 95% CI: 0.71–0.94) but not HHF (hazard ratio = 0.995, 95% CI: 0.924–1.07). Landmark analysis showed no significant difference in outcomes for follow-up durations exceeding 2 years.ConclusionMRA had a neutral effect on cardiovascular death and HHF, while RASI/ARNI was associated with a lower risk of cardiovascular death. RASI/ARNI may be more beneficial than MRA for HFmrEF patients. Regular re-evaluation is essential to adjust heart failure treatment.https://www.frontiersin.org/articles/10.3389/fphar.2024.1507326/fullHFmrEFcardiovascular outcomesreninangiotensin system inhibitorangiotensin receptor neprilysin inhibitorMRA (magnetic resonance angiography) |
| spellingShingle | Chia-Chen Lee David Te-Wei Kuan Kai-Chun Chang Zheng-Wei Chen Zheng-Wei Chen Jen-Fang Cheng Jen-Fang Cheng Ting-Tse Lin Ting-Tse Lin Lian-Yu Lin Lian-Yu Lin Cho-Kai Wu Cho-Kai Wu Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction Frontiers in Pharmacology HFmrEF cardiovascular outcomes reninangiotensin system inhibitor angiotensin receptor neprilysin inhibitor MRA (magnetic resonance angiography) |
| title | Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| title_full | Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| title_fullStr | Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| title_full_unstemmed | Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| title_short | Comparative analysis of mineralocorticoid receptor antagonists and renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| title_sort | comparative analysis of mineralocorticoid receptor antagonists and renin angiotensin system inhibitors angiotensin receptor neprilysin inhibitor in heart failure with mildly reduced ejection fraction |
| topic | HFmrEF cardiovascular outcomes reninangiotensin system inhibitor angiotensin receptor neprilysin inhibitor MRA (magnetic resonance angiography) |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1507326/full |
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