Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis

Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Berbenetz, Nicolas M. [verfasserIn] Mrkobrada, Marko

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2016

Schlagwörter:	Heart failure Heart failure with reduced ejection fraction Heart failure with preserved ejection fraction Mineralocorticoid receptor antagonists Systematic review

Anmerkung:	© The Author(s). 2016

Übergeordnetes Werk:	Enthalten in: BMC cardiovascular disorders - London : BioMed Central, 2001, 16(2016), 1 vom: 01. Dez.
Übergeordnetes Werk:	volume:16 ; year:2016 ; number:1 ; day:01 ; month:12

Links:	Volltext

DOI / URN:	10.1186/s12872-016-0425-x

Katalog-ID:	SPR027342344

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520			\|a Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia.
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publishDate	2016
allfields	10.1186/s12872-016-0425-x doi (DE-627)SPR027342344 (SPR)s12872-016-0425-x-e DE-627 ger DE-627 rakwb eng Berbenetz, Nicolas M. verfasserin aut Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213 Mrkobrada, Marko aut Enthalten in BMC cardiovascular disorders London : BioMed Central, 2001 16(2016), 1 vom: 01. Dez. (DE-627)335488870 (DE-600)2059859-2 1471-2261 nnns volume:16 year:2016 number:1 day:01 month:12 https://dx.doi.org/10.1186/s12872-016-0425-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 01 12
spelling	10.1186/s12872-016-0425-x doi (DE-627)SPR027342344 (SPR)s12872-016-0425-x-e DE-627 ger DE-627 rakwb eng Berbenetz, Nicolas M. verfasserin aut Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213 Mrkobrada, Marko aut Enthalten in BMC cardiovascular disorders London : BioMed Central, 2001 16(2016), 1 vom: 01. Dez. (DE-627)335488870 (DE-600)2059859-2 1471-2261 nnns volume:16 year:2016 number:1 day:01 month:12 https://dx.doi.org/10.1186/s12872-016-0425-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 01 12
allfields_unstemmed	10.1186/s12872-016-0425-x doi (DE-627)SPR027342344 (SPR)s12872-016-0425-x-e DE-627 ger DE-627 rakwb eng Berbenetz, Nicolas M. verfasserin aut Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213 Mrkobrada, Marko aut Enthalten in BMC cardiovascular disorders London : BioMed Central, 2001 16(2016), 1 vom: 01. Dez. (DE-627)335488870 (DE-600)2059859-2 1471-2261 nnns volume:16 year:2016 number:1 day:01 month:12 https://dx.doi.org/10.1186/s12872-016-0425-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 01 12
allfieldsGer	10.1186/s12872-016-0425-x doi (DE-627)SPR027342344 (SPR)s12872-016-0425-x-e DE-627 ger DE-627 rakwb eng Berbenetz, Nicolas M. verfasserin aut Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213 Mrkobrada, Marko aut Enthalten in BMC cardiovascular disorders London : BioMed Central, 2001 16(2016), 1 vom: 01. Dez. (DE-627)335488870 (DE-600)2059859-2 1471-2261 nnns volume:16 year:2016 number:1 day:01 month:12 https://dx.doi.org/10.1186/s12872-016-0425-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 01 12
allfieldsSound	10.1186/s12872-016-0425-x doi (DE-627)SPR027342344 (SPR)s12872-016-0425-x-e DE-627 ger DE-627 rakwb eng Berbenetz, Nicolas M. verfasserin aut Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2016 Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213 Mrkobrada, Marko aut Enthalten in BMC cardiovascular disorders London : BioMed Central, 2001 16(2016), 1 vom: 01. Dez. (DE-627)335488870 (DE-600)2059859-2 1471-2261 nnns volume:16 year:2016 number:1 day:01 month:12 https://dx.doi.org/10.1186/s12872-016-0425-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 16 2016 1 01 12
language	English
source	Enthalten in BMC cardiovascular disorders 16(2016), 1 vom: 01. Dez. volume:16 year:2016 number:1 day:01 month:12
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topic_facet	Heart failure Heart failure with reduced ejection fraction Heart failure with preserved ejection fraction Mineralocorticoid receptor antagonists Systematic review
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author	Berbenetz, Nicolas M.
spellingShingle	Berbenetz, Nicolas M. misc Heart failure misc Heart failure with reduced ejection fraction misc Heart failure with preserved ejection fraction misc Mineralocorticoid receptor antagonists misc Systematic review Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis
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topic_title	Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis Heart failure (dpeaa)DE-He213 Heart failure with reduced ejection fraction (dpeaa)DE-He213 Heart failure with preserved ejection fraction (dpeaa)DE-He213 Mineralocorticoid receptor antagonists (dpeaa)DE-He213 Systematic review (dpeaa)DE-He213
topic	misc Heart failure misc Heart failure with reduced ejection fraction misc Heart failure with preserved ejection fraction misc Mineralocorticoid receptor antagonists misc Systematic review
topic_unstemmed	misc Heart failure misc Heart failure with reduced ejection fraction misc Heart failure with preserved ejection fraction misc Mineralocorticoid receptor antagonists misc Systematic review
topic_browse	misc Heart failure misc Heart failure with reduced ejection fraction misc Heart failure with preserved ejection fraction misc Mineralocorticoid receptor antagonists misc Systematic review
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author_browse	Berbenetz, Nicolas M. Mrkobrada, Marko
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author-letter	Berbenetz, Nicolas M.
doi_str_mv	10.1186/s12872-016-0425-x
title_sort	mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis
title_auth	Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis
abstract	Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. © The Author(s). 2016
abstractGer	Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. © The Author(s). 2016
abstract_unstemmed	Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF. Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We included randomized controlled trials (RCT) of MRAs in adults with HFpEF or HFrEF if they reported data on major adverse cardiac events or drug safety. Results We identified 15 studies representing 16321 patients. MRAs were associated with a reduced risk of cardiovascular death (RR 0.81 [0.75–0.87], $ I^{2} $ 0%), all-cause mortality (RR 0.83 [0.77–0.88], $ I^{2} $ 0%), and cardiac hospitalizations (RR 0.80 [0.70–0.92], $ I^{2} $ 58.4%). However, an a-priori specified subgroup analysis demonstrated that these benefits were limited to HFrEF (cardiovascular death RR 0.79 [0.73–0.86], $ I^{2} $ 0%; all-cause mortality RR 0.81 [0.75–0.87], $ I^{2} $ 0%; cardiac hospitalizations RR 0.76 [0.64–0.90], $ I^{2} $ 68%), but not HFpEF (all-cause mortality RR 0.92 [0.79–1.08], $ I^{2} $ 0%; cardiac hospitalizations RR 0.91 [0.67–1.24], $ I^{2} $ 17%). MRAs increased the risk of hyperkalemia (RR 2.03 [1.78–2.31], $ I^{2} $ 0%). Nonselective MRAs, but not selective MRAs increased the risk of gynecomastia (RR 7.37 [4.42–12.30], $ I^{2} $ 0% vs. RR 0.74 [0.43–1.27], $ I^{2} $ 0%). Evidence was of moderate quality for cardiovascular death, all-cause mortality and cardiovascular hospitalizations; and high-quality for hyperkalemia and gynecomastia. Conclusions MRAs reduce the risk of adverse cardiac events in HFrEF but not HFpEF. MRA use in HFpEF increases the risk of harm from hyperkalemia and gynecomastia. Selective MRAs are equally effective as nonselective MRAs, without a risk of gynecomastia. © The Author(s). 2016
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title_short	Mineralocorticoid receptor antagonists for heart failure: systematic review and meta-analysis
url	https://dx.doi.org/10.1186/s12872-016-0425-x
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