{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T09:40:08Z","timestamp":1793785208518,"version":"4.6.1"},"reference-count":118,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Aims<\/jats:title>\n                  <jats:p>Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in a variety of settings. This study aimed to assess whether cardioprotective effects of MRAs are modified by heart failure (HF) and atrial fibrillation (AF) status and to study their impact on AF events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>MEDLINE, Embase, and Cochrane Central databases were searched to 24 March 2023 for randomized controlled trials evaluating the efficacy of MRAs as compared with placebo or usual care in reducing cardiovascular outcomes and AF events in patients with or at risk for cardiovascular diseases. Random-effects models and interaction analyses were used to test for effect modification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Meta-analysis of seven trials (20 741 participants, mean age: 65.6 years, 32% women) showed that the efficacy of MRAs, as compared with placebo, in reducing a composite of cardiovascular death or HF hospitalization remains consistent across patients with HF [risk ratio = 0.81; 95% confidence interval (CI): 0.67\u20130.98] and without HF (risk ratio = 0.84; 95% CI: 0.75\u20130.93; interaction P = .77). Among patients with HF, MRAs reduced cardiovascular death or HF hospitalization in patients with AF (hazard ratio = 0.95; 95% CI: 0.54\u20131.66) to a similar extent as in those without AF (hazard ratio = 0.82; 95% CI: 0.63\u20131.07; interaction P = .65). Pooled data from 20 trials (21 791 participants, mean age: 65.2 years, 31.3% women) showed that MRAs reduce AF events (risk ratio = 0.76; 95% CI: 0.67\u20130.87) in both patients with and without prior AF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mineralocorticoid receptor antagonists are similarly effective in preventing cardiovascular events in patients with and without HF and most likely retain their efficacy regardless of AF status. Mineralocorticoid receptor antagonists may also be moderately effective in preventing incident or recurrent AF events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad811","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:02:25Z","timestamp":1704844945000},"page":"756-774","source":"Crossref","is-referenced-by-count":56,"title":["Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-2930","authenticated-orcid":false,"given":"Alireza","family":"Oraii","sequence":"first","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1216-7580","authenticated-orcid":false,"given":"Jeff S","family":"Healey","sequence":"additional","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"},{"name":"Division of Cardiology, Department of Medicine, McMaster University , 1200 Main Street West, Hamilton, ON L8N 3Z5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-7205","authenticated-orcid":false,"given":"Krzysztof","family":"Kowalik","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine, McMaster University , Hamilton, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9554-040X","authenticated-orcid":false,"given":"Avinash K","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2555-1266","authenticated-orcid":false,"given":"Alexander P","family":"Benz","sequence":"additional","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2527-8936","authenticated-orcid":false,"given":"Jorge A","family":"Wong","sequence":"additional","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"},{"name":"Division of Cardiology, Department of Medicine, McMaster University , 1200 Main Street West, Hamilton, ON L8N 3Z5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-5251","authenticated-orcid":false,"given":"David","family":"Conen","sequence":"additional","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"},{"name":"Division of Cardiology, Department of Medicine, McMaster University , 1200 Main Street West, Hamilton, ON L8N 3Z5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-7542","authenticated-orcid":false,"given":"William F","family":"McIntyre","sequence":"additional","affiliation":[{"name":"Population Health Research Institute , McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2 , Canada"},{"name":"Division of Cardiology, Department of Medicine, McMaster University , 1200 Main Street West, Hamilton, ON L8N 3Z5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"2024030720271091800_ehad811-B1","doi-asserted-by":"crossref","first-page":"T125","DOI":"10.1530\/JOE-16-0600","article-title":"30 years of the mineralocorticoid receptor: mineralocorticoid receptor antagonists: 60 years of research and development","volume":"234","author":"Kolkhof","year":"2017","journal-title":"J Endocrinol"},{"key":"2024030720271091800_ehad811-B2","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. 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