REVIEW article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1564860
This article is part of the Research TopicAdvancement in Personalized Cardiovascular Treatment for Heart FailureView all articles
To MRAs treatment or not? Evidence from a meta-analysis of randomized controlled trials of different MRAs on Cardiovascular Health in Heart Failure
Provisionally accepted
- 1Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- 2Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Mineralocorticoid receptor antagonists (MRAs) are pivotal in heart failure (HF) management.Objectives: This study evaluates their impact on adverse cardiovascular events and left ventricular ejection fraction (LVEF) in HF patients.Methods: A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials databases, with a cutoff date of September 30, 2024. All included studies were randomized controlled trials (RCTs) that recorded the incidence of adverse cardiovascular events and changes in LVEF after MRA treatment in HF patients.Results: A total of 30 randomized controlled trials involving 24,831 patients with heart failure were included. Compared to conventional therapy or placebo, treatment with MRAs significantly reduced the risk of all-cause mortality (RR=0.862, 95%CI: 0.778 -0.956, p=0.005; I ² =36.1%), cardiovascular mortality (RR=0.828, 95%CI: 0.732 -0.937, p=0.003; I ² =45.7%), and heart failure-related hospitalization (RR=0.780, 95%CI: 0.657 -0.926, p=0.005; I ² =65.5%). Moreover, MRAs significantly improved LVEF (WMD=1.384, 95%CI: 0.208 -2.559, p=0.021; I ² =59.9%). However, MRA therapy was associated with an increased risk of renal dysfunction, including hyperkalemia (RR=2.086, 95%CI: 1.872-2.325, p<0.001; I² =0.0%), elevated serum creatinine (RR=1.512, 95%CI: 1.252 -1.825, p<0.001; I ² =0.0%), decreased eGFR (WMD=-5.223, 95%CI: -7.380 to -3.066, p<0.001; I ² =0.0%), and potentially increased incidence of composite renal outcomes.MRAs significantly reduce the risk of adverse cardiovascular events in patients with heart failure and contribute to LVEF improvement. They lower all-cause mortality in patients with HFrEF and reduce hospitalization for heart failure in those with HFmrEF or HFpEF. However, the potential risk of renal-related adverse events warrants close monitoring.
Keywords: Heart Failure, Mineralocorticoid Receptor Antagonists, All-cause mortality, Cardiovascular death, Meta-analysis MRAs: Mineralocorticoid Receptor Antagonists, BNP: Brain natriuretic peptide, CKD: Chronic kidney disease, LVEF: Left ventricular ejection fraction
Received: 22 Jan 2025; Accepted: 10 Jul 2025.
Copyright: © 2025 何, Zhang, Huo, Xue, Wang, Zhong, Xiao, Shen and Feng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jian Feng, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.