Evidence map›Paper›PMID 40959489›Full record

SynthesisFrontiers in cardiovascular medicine2025

Mineralocorticoid receptor antagonists in heart failure: a systematic review and meta-analysis.

Yue Zhang, Yin-Chao Bao, Li-Xia Wang, Hong-Juan Zhao, Jing Sun, Lin Sun, Wei Duan, Ming Du, Lei-Jun Wang, Qin-Yan An and 1 more

Abstract readSystematic Review
In one paragraph

Synthesis in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Yue Zhang *Tongji University School of Medicine, Shanghai, China.
Yin-Chao Bao *Tongji University School of Medicine, Shanghai, China.
Li-Xia WangDepartment of General Practice, Datuan Community Health Service Center, Pudong New Area, Shanghai, China.
Hong-Juan ZhaoDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Jing SunDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Lin SunDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Wei DuanDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Ming DuDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Lei-Jun WangDepartment of Cardiology, Sijing Hospital of Songjiang District, Shanghai, China.
Qin-Yan AnDepartment of Respiratory, Sijing Hospital of Songjiang District, Shanghai, China.
Wen-Ze YangDepartment of Cardiology, Jiuquan Hospital Affiliated to Shanghai First People's Hospital, Jiuquan City, Gansu, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Mineralocorticoid receptor over-activation drives maladaptive myocardial fibrosis, vascular inflammation and renal sodium retention across the entire spectrum of left ventricular ejection fraction (LVEF). While steroidal MRAs have convincingly reduced hospitalizations and mortality in patients with heart failure and reduced EF (HFrEF), evidence remains fragmented for heart failure with mildly reduced (HFmrEF) or preserved EF (HFpEF), and no head-to-head data distinguish steroidal from non-steroidal agents. This study aimed to evaluate the effect of MRAs in patients with HF across the range of ejection fraction. Methods: Searched PubMed, Web of Science, Wanfang and Cochrane library (1 Jan 1987-10 Sep 2024) for randomized clinical trials (RCT) assessing MRAs (finerenone, spironolactone, eplerenone) in HFpEF, HFmrEF or HF. The primary endpoint was composite cardiovascular (CV) outcomes. Secondary endpoints included CV mortality, overall HF exacerbation events, safety, and adverse events. A meta-analysis was conducted using hazard ratios (HR), confidence intervals (CI), and relative risks (RR) to synthesize the findings. Results: In the analysis of nine RCTs, MRAs were associated with a 23% reduction in CV composite outcomes (RR: 0.77, 95% CI: 0.72-0.83, Conclusions: MRAs should be considered for patients with HFrEF due to their substantial benefits. In HFmrEF or HFpEF, MRAs may confer benefit, though the effect is modest and hyperkalemia risk is higher, mandating close potassium monitoring. Systematic Review Registration: PROSPERO CRD42022304966.

Indexed as

heart failure and reduced ejection fractionHF and mildly reduced ejection fractionHF with preserved ejection fractionhyperkalemiamineralocorticoid receptor antagonists

Identifiers

PMID40959489
PMCPMC12434096

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.