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Geng C, Mao YC, Qi SF, Song K, Wang HF, Zhang ZY, Tian QB. Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat. Front Cardiovasc Med 2023; 10:1236008. [PMID: 38028498 PMCID: PMC10657990 DOI: 10.3389/fcvm.2023.1236008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Aims Recent studies have shown that mineralocorticoid receptor antagonists (MRAs) can decrease mortality in patients with heart failure; however, the application of MRAs in current clinical practice is limited because of adverse effects such as hyperkalemia that occur with treatment. Therefore, this meta-analysis used the number needed to treat (NNT) to assess the efficacy and safety of MRAs in patients with chronic heart failure. Methods We meta-analysed randomized controlled trials (RCTs) which contrasted the impacts of MRAs with placebo. As of March 2023, all articles are published in English. The primary outcome was major adverse cardiovascular events (MACE), and secondary outcomes included all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and adverse events. Results We incorporated seven studies with a total of 9,056 patients, 4,512 of whom received MRAs and 4,544 of whom received a placebo, with a mean follow-up period of 2.1 years. MACE, all-cause mortality, and cardiovascular mortality were all reduced by MRAs, with corresponding numbers needed to treat for benefit (NNTB) of 37, 28, and 34; as well as no impact on MI or stroke. MRAs increased the incidence of hyperkalemia and gynecomastia, with the corresponding mean number needed to treat for harm (NNTH) of 18 and 52. Conclusions This study showed that enabling one patient with HF to avoid MACE required treating 37 patients with MRAs for 2.1 years. MRAs reduce MACE, all-cause mortality, and cardiovascular death; however, they increase the risk of hyperkalemia and gynecomastia.
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Affiliation(s)
| | | | | | | | | | | | - Qing-Bao Tian
- Hebei Key Laboratory of Environment and Human Health, Department of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China
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Then C, Herder C, Heier M, Meisinger C, Koenig W, Rathmann W, Sujana C, Roden M, Bidlingmaier M, Seissler J, Thorand B, Peters A, Reincke M. Association of Aldosterone with Mortality in the General Population. Exp Clin Endocrinol Diabetes 2023; 131:307-313. [PMID: 36787884 DOI: 10.1055/a-2035-6179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Aldosterone excess is linked to cardiovascular events and mortality as well as to low-grade inflammation in the context of metabolic diseases. Whether mildly elevated aldosterone levels in the general population promote cardiovascular risk is still under debate. We analyzed the association of plasma aldosterone concentrations with incident cardiovascular events, cardiovascular and all-cause mortality as well as with biomarkers of subclinical inflammation in the population-based KORA F4 study. METHODS Plasma aldosterone concentrations were measured with an in-house immunoflurometric assay. The analyses included 2935 participants (n=1076 for selected biomarkers of subclinical inflammation) with a median follow-up of 8.7 (8.2; 9.1) years. The associations were estimated using Cox proportional hazard and linear regression models adjusted for renin, sex, age, body mass index, arterial hypertension, diabetes, estimated glomerular filtration rate, low- and high-density lipoprotein cholesterol, physical activity, smoking, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics and calcium channel blockers. RESULTS Aldosterone was significantly associated with all-cause mortality (hazard ratio per standard deviation increase: 1.20; 95% confidence interval 1.04-1.37), but not with cardiovascular mortality, incident cardiovascular events, or with biomarkers of subclinical inflammation. CONCLUSIONS Aldosterone was associated with all-cause mortality in the population-based KORA F4 study, but the previously described associations of excess aldosterone with cardiovascular complications and biomarkers of subclinical inflammation could not be shown.
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Affiliation(s)
- Cornelia Then
- Department of Internal Medicine IV, University Hospital of Ludwig-Maximilians-University Munich, Germany
- German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf; Germany
| | - Margit Heier
- Institute of Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Germany
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Christa Meisinger
- KORA Study Centre, University Hospital Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Wolfgang Koenig
- Chair of Epidemiology, University Hospital Augsburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany
- German Heart Center Munich, Technical University of Munich, Germany
| | - Chaterina Sujana
- Institute of Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf; Germany
| | - Martin Bidlingmaier
- Department of Internal Medicine IV, University Hospital of Ludwig-Maximilians-University Munich, Germany
| | - Jochen Seissler
- Department of Internal Medicine IV, University Hospital of Ludwig-Maximilians-University Munich, Germany
| | - Barbara Thorand
- Institute of Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Germany
| | - Annette Peters
- Institute of Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Germany
- Chair of Epidemiology, University Hospital Augsburg, Germany
| | - Martin Reincke
- Department of Internal Medicine IV, University Hospital of Ludwig-Maximilians-University Munich, Germany
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Wu Y, Lin H, Tao Y, Xu Y, Chen J, Jia Y, Zheng Z. Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease. Front Pharmacol 2022; 13:967317. [PMID: 36188560 PMCID: PMC9523214 DOI: 10.3389/fphar.2022.967317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/24/2022] [Indexed: 12/19/2022] Open
Abstract
Diabetic kidney disease (DKD) is one of the major causes of end-stage renal disease (ESRD). To evaluate the efficacy and safety of different types of mineralocorticoid receptor antagonists (MRAs) in diabetic kidney disease patients, we conducted this network meta-analysis by performing a systematic search in PubMed, MEDLINE, EMBASE, Web of Science, the Cochrane Library, and Clinicaltrials.gov. A total of 12 randomized clinical trials with 15,492 patients applying various types of MRAs covering spironolactone, eplerenone, finerenone, esaxerenone, and apararenone were included. The efficacy outcomes were the ratio of urine albumin creatine ratio (UACR) at posttreatment vs. at baseline, change in posttreatment estimated glomerular filtration (eGFR) vs. at baseline, and change in posttreatment systolic blood pressure (SBP) vs. at baseline. The safety outcome was the number of patients suffering from hyperkalemia. High-dose finerenone (MD −0.31, 95% CI: −0.52, −0.11), esaxerenone (MD −0.54, 95% CI: −0.72, −0.30), and apararenone (MD −0.63, 95% CI: −0.90, −0.35) were associated with a superior reduction in proteinuria in patients with DKD. Regarding the change in eGFR, the results of all drugs were similar, and finerenone may have potential superiority in protecting the kidney. Compared with placebo, none of the treatments was associated with a higher probability of controlling systolic blood pressure during treatment. Moreover, spironolactone, esaxerenone, and 20 mg of finerenone presented a higher risk of hyperkalemia. This Bayesian network meta-analysis was the first to explore the optimal alternative among MRAs in the treatment of DKD and revealed the superiority of 20 mg of finerenone among MRAs in treating DKD. Systematic Review Registration: PROSPERO, identifier (CRD42022313826)
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Affiliation(s)
- Yichuan Wu
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
| | - Huanjia Lin
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
| | - Yuan Tao
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
| | - Ying Xu
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
| | - Jiaqi Chen
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
| | - Yijie Jia
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
- *Correspondence: Zongji Zheng, ; Yijie Jia,
| | - Zongji Zheng
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
- De Feng Academy, Southern Medical University, Guangzhou, China
- *Correspondence: Zongji Zheng, ; Yijie Jia,
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Bienvenu LA, Bell JR, Weeks KL, Delbridge LMD, Young MJ. New Perspectives on Sex Steroid and Mineralocorticoid Receptor Signaling in Cardiac Ischemic Injury. Front Physiol 2022; 13:896425. [PMID: 35846011 PMCID: PMC9277457 DOI: 10.3389/fphys.2022.896425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
The global burden of ischemic heart disease is burgeoning for both men and women. Although advances have been made, the need for new sex-specific therapies targeting key differences in cardiovascular disease outcomes in men and women remains. Mineralocorticoid receptor directed treatments have been successfully used for blood pressure control and heart failure management and represent a potentially valuable therapeutic option for ischemic cardiac events. Clinical and experimental data indicate that mineralocorticoid excess or inappropriate mineralocorticoid receptor (MR) activation exacerbates ischemic damage, and many of the intracellular response pathways activated in ischemia and subsequent reperfusion are regulated by MR. In experimental contexts, where MR are abrogated genetically or mineralocorticoid signaling is suppressed pharmacologically, ischemic injury is alleviated, and reperfusion recovery is enhanced. In the chronic setting, mineralocorticoid signaling induces fibrosis, oxidative stress, and inflammation, which can predispose to ischemic events and exacerbate post-myocardial infarct pathologies. Whilst a range of cardiac cell types are involved in mineralocorticoid-mediated regulation of cardiac function, cardiomyocyte-specific MR signaling pathways are key. Selective inhibition of cardiomyocyte MR signaling improves electromechanical resilience during ischemia and enhances contractile recovery in reperfusion. Emerging evidence suggests that the MR also contribute to sex-specific aspects of ischemic vulnerability. Indeed, MR interactions with sex steroid receptors may differentially regulate myocardial nitric oxide bioavailability in males and females, potentially determining sex-specific post-ischemic outcomes. There is hence considerable impetus for exploration of MR directed, cell specific therapies for both women and men in order to improve ischemic heart disease outcomes.
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Affiliation(s)
- Laura A. Bienvenu
- Molecular Imaging and Theranostics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
| | - James R. Bell
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Bundoora, VIC, Australia
- *Correspondence: James R. Bell,
| | - Kate L. Weeks
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, Australia
| | - Lea M. D. Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, Australia
| | - Morag J. Young
- Baker Department of Cardiometabolic Health, University of Melbourne VIC, Melbourne, VIC, Australia
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Galimzhanov A, Sabitov Y, Tenekecioglu E, Tun HN, Alasnag M, Mamas MA. Baseline platelet count in percutaneous coronary intervention: a dose-response meta-analysis. Heart 2022; 108:heartjnl-2022-320910. [PMID: 35613715 DOI: 10.1136/heartjnl-2022-320910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/11/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI. METHODS A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs. RESULTS The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×109/L), while a predominant ischaemic risk was observed at high platelet counts (>250×109/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively). CONCLUSION Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events. PROSPERO REGISTRATION NUMBER CRD42021283270.
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Affiliation(s)
- Akhmetzhan Galimzhanov
- Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan
| | - Yersyn Sabitov
- Rentgen-endovascular Laboratory, Semey Medical University, Semey, East Kazakhstan, Kazakhstan
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
- Department of Cardiology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Han Naung Tun
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Mirvat Alasnag
- Cardiovascular Department, King Fahd Armed Forces Hospital, Jeddah, Makkah, Saudi Arabia
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
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