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Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat

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, thi...

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Autores principales: Geng, Chang, Mao, Yu-Cheng, Qi, Su-fen, Song, Kai, Wang, Hong-Fei, Zhang, Zi-yan, Tian, Qing-Bao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657990/
https://www.ncbi.nlm.nih.gov/pubmed/38028498
http://dx.doi.org/10.3389/fcvm.2023.1236008
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author Geng, Chang
Mao, Yu-Cheng
Qi, Su-fen
Song, Kai
Wang, Hong-Fei
Zhang, Zi-yan
Tian, Qing-Bao
author_facet Geng, Chang
Mao, Yu-Cheng
Qi, Su-fen
Song, Kai
Wang, Hong-Fei
Zhang, Zi-yan
Tian, Qing-Bao
author_sort Geng, Chang
collection PubMed
description 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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spelling pubmed-106579902023-01-01 Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat Geng, Chang Mao, Yu-Cheng Qi, Su-fen Song, Kai Wang, Hong-Fei Zhang, Zi-yan Tian, Qing-Bao Front Cardiovasc Med Cardiovascular Medicine 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. Frontiers Media S.A. 2023-11-06 /pmc/articles/PMC10657990/ /pubmed/38028498 http://dx.doi.org/10.3389/fcvm.2023.1236008 Text en © 2023 Geng, Mao, Qi, Song, Wang, Zhang and Tian. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 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.
spellingShingle Cardiovascular Medicine
Geng, Chang
Mao, Yu-Cheng
Qi, Su-fen
Song, Kai
Wang, Hong-Fei
Zhang, Zi-yan
Tian, Qing-Bao
Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title_full Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title_fullStr Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title_full_unstemmed Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title_short Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
title_sort mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657990/
https://www.ncbi.nlm.nih.gov/pubmed/38028498
http://dx.doi.org/10.3389/fcvm.2023.1236008
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