Joycie Chang BA , Andrew P. Ambrosy MD , Orly Vardeny PharmD, MS , Harriette G.C. Van Spall MD, MPH , Robert J. Mentz MD , Andrew J. Sauer MD
{"title":"矿物质皮质激素拮抗剂在心力衰竭中的作用：已确立和新出现的治疗作用。","authors":"Joycie Chang BA , Andrew P. Ambrosy MD , Orly Vardeny PharmD, MS , Harriette G.C. Van Spall MD, MPH , Robert J. Mentz MD , Andrew J. Sauer MD","doi":"10.1016/j.jchf.2024.08.007","DOIUrl":null,"url":null,"abstract":"<div><div>The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 1979-1993"},"PeriodicalIF":10.3000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mineralocorticoid Antagonism in Heart Failure\",\"authors\":\"Joycie Chang BA , Andrew P. Ambrosy MD , Orly Vardeny PharmD, MS , Harriette G.C. Van Spall MD, MPH , Robert J. Mentz MD , Andrew J. Sauer MD\",\"doi\":\"10.1016/j.jchf.2024.08.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.</div></div>\",\"PeriodicalId\":14687,\"journal\":{\"name\":\"JACC. Heart failure\",\"volume\":\"12 12\",\"pages\":\"Pages 1979-1993\"},\"PeriodicalIF\":10.3000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Heart failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213177924006061\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Heart failure","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213177924006061","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.
期刊介绍：
JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.
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