Nonsteroidal mineralocorticoid receptor antagonists (finerenone) significantly reduce cardiovascular death and heart failure hospitalizations in heart failure patients with LVEF ≥ 40%.
Do nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) like finerenone reduce cardiovascular death and heart failure hospitalizations in patients with HFmrEF and HFpEF?
Nonsteroidal MRAs such as finerenone establish a new foundation for the management of HFmrEF and HFpEF, offering significant cardiorenal benefits.
The therapeutic landscape for heart failure (HF), particularly in patients with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF), has historically been characterized by limited effective disease-modifying options. The recent approval of nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), specifically finerenone, represents a major paradigm shift. This review synthesizes contemporary evidence, including the landmark FINEARTS-HF trial, which demonstrated significant reductions in cardiovascular death and heart failure hospitalizations in patients with left ventricular ejection fraction (LVEF) ≥ 40%. These findings contrast with the neutral overall results and subgroup limitations observed with steroidal MRAs such as spironolactone in the TOPCAT trial. Mechanistic distinctions, cardiorenal benefits, and emerging metabolic effects of finerenone are explored alongside its complementary role with sodium–glucose cotransporter-2 (SGLT2) inhibitors. Practical considerations for implementation, including patient selection, dosing, monitoring, and combination therapy strategies, are discussed. Overall, nsMRAs establish a new foundation for the management of HFmrEF and HFpEF and represent a critical advancement in contemporary heart failure therapeutics.
Al‐Horani et al. (Thu,) conducted a review in Heart failure with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF). Nonsteroidal mineralocorticoid receptor antagonists (finerenone) vs. Steroidal MRAs (spironolactone) was evaluated on Cardiovascular death and heart failure hospitalizations. Nonsteroidal mineralocorticoid receptor antagonists (finerenone) significantly reduce cardiovascular death and heart failure hospitalizations in heart failure patients with LVEF ≥ 40%.