{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:51:38Z","timestamp":1754153498650,"version":"3.41.2"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Mineralocorticoid receptor antagonists (MRAs) are pivotal in heart failure (HF) management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study evaluates their impact on adverse cardiovascular events and left ventricular ejection fraction (LVEF) in HF patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials databases, with a cutoff date of September 30, 2024. All included studies were randomized controlled trials (RCTs) that recorded the incidence of adverse cardiovascular events and changes in LVEF after MRA treatment in HF patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 30 randomized controlled trials involving 24,831 patients with heart failure were included. Compared to conventional therapy or placebo, treatment with MRAs significantly reduced the risk of all-cause mortality (RR\u2009=\u20090.862, 95% CI: 0.778\u20130.956, <jats:italic>p<\/jats:italic>\u2009=\u20090.005; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200936.1%), cardiovascular mortality (RR\u2009=\u20090.828, 95% CI: 0.732\u20130.937, <jats:italic>p<\/jats:italic>\u2009=\u20090.003; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200945.7%), and heart failure-related hospitalization (RR\u2009=\u20090.780, 95% CI: 0.657\u20130.926, <jats:italic>p<\/jats:italic>\u2009=\u20090.005; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200965.5%). Moreover, MRAs significantly improved LVEF (WMD\u2009=\u20091.384, 95% CI: 0.208\u20132.559, <jats:italic>p<\/jats:italic>\u2009=\u20090.021; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200959.9%). However, MRA therapy was associated with an increased risk of renal dysfunction, including hyperkalemia (RR\u2009=\u20092.086, 95% CI: 1.872\u20132.325, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.0%), elevated serum creatinine (RR\u2009=\u20091.512, 95% CI: 1.252\u20131.825, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.0%), decreased eGFR (WMD\u2009=\u2009\u22125.223, 95% CI: \u22127.380 to \u22123.066, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.0%), and potentially increased incidence of composite renal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MRAs significantly reduce the risk of adverse cardiovascular events in patients with heart failure and contribute to LVEF improvement. They lower all-cause mortality in patients with HFrEF and reduce hospitalization for heart failure in those with HFmrEF or HFpEF. However, the potential risk of renal-related adverse events warrants close monitoring.\n<\/jats:p><jats:p>Our protocol was registered in PROSPERO (registration number: CRD42024592012).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1564860","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T05:37:15Z","timestamp":1753249035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["To MRAs treatment or not? evidence from a meta-analysis of randomized controlled trials of different MRAs on cardiovascular health in heart failure"],"prefix":"10.3389","volume":"12","author":[{"given":"Jinyu","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujia","family":"Huo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haojie","family":"Xue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongping","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1002\/ejhf.2115","article-title":"Universal definition and classification of heart failure: a report of the heart failure society of America, heart failure association of the European Society of Cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure: endorsed by the Canadian heart failure society, heart failure association of India, cardiac society of Australia and New Zealand, and Chinese heart failure association","volume":"23","author":"Bozkurt","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"392","year":"2018","journal-title":"Lancet (London, England)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1161\/CIR.0000000000001063","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1002\/j.2040-4603.2016.tb00669.x","article-title":"Pathophysiology of heart failure","volume":"6","author":"Tanai","year":"2015","journal-title":"Compr Physiol"},{"key":"B5","doi-asserted-by":"publisher","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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