{
    "abstract": "Spironolactone, a steroidal mineralocorticoid receptor antagonist (MRA), has been used to treat patients with heart failure (HF) for more than half a century. Spironolactone improved outcomes in patients with severely symptomatic HF with reduced ejection fraction, and later, eplerenone expanded the benefits to patients with mildly symptomatic HF with reduced ejection fraction and myocardial infarction complicated by HF. Spironolactone reduced HF events in some patients with HF with preserved ejection fraction, but the results were not generalizable to all patients with HF with preserved ejection fraction. More recently, the nonsteroidal MRA finerenone improved the HF outcomes of patients with HF with preserved ejection fraction, expanding the benefits previously seen among patients with diabetes and albuminuric chronic kidney disease. The use of MRAs has been limited due to excessive concern about hyperkalemia. Education about the limited true risk associated with hyperkalemia, and about how to predict, prevent, and manage hyperkalemia, may lead to wider acceptability and use of these agents. Several ongoing trials are testing steroidal and nonsteroidal MRAs in HF populations. In this review, we perform a critical appraisal of MRA use in HF populations and point toward future directions.",
    "authors": [
        {
            "affiliation": "Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Centre - UnIC@RISE, Faculty of Medicine of the University of Porto, Portugal (J.P.F.).\nHeart Failure Clinic, Internal Medicine Department, Unidade Local de Saude de Gaia/Espinho, Gaia, Portugal (J.P.F.).\nUniversit\u00e9 de Lorraine, Inserm, Centre d'Investigation Clinique Plurith\u00e9matique 1433, Nancy, France (J.P.F., F.Z.).",
            "firstname": "Jo\u00e3o Pedro",
            "initials": "JP",
            "lastname": "Ferreira"
        },
        {
            "affiliation": "University of Michigan School of Medicine, Ann Arbor (B.P.).",
            "firstname": "Bertram",
            "initials": "B",
            "lastname": "Pitt"
        },
        {
            "affiliation": "Universit\u00e9 de Lorraine, Inserm, Centre d'Investigation Clinique Plurith\u00e9matique 1433, Nancy, France (J.P.F., F.Z.).",
            "firstname": "Faiez",
            "initials": "F",
            "lastname": "Zannad"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1161/CIRCHEARTFAILURE.124.011629",
    "journal": "Circulation. Heart failure",
    "keywords": [
        "eplerenone",
        "finerenone",
        "heart failure",
        "spironolactone",
        "steroids"
    ],
    "methods": null,
    "publication_date": "2024-11-25",
    "pubmed_id": "39584253",
    "results": null,
    "title": "Mineralocorticoid Receptor Antagonists in Heart Failure: An Update.",
    "xml": "<Element 'PubmedArticle' at 0x788502c659e0>"
}