{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:04:32Z","timestamp":1777352672933,"version":"3.51.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,14]]},"DOI":"10.7759\/cureus.45241","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T16:21:19Z","timestamp":1694708479000},"source":"Crossref","is-referenced-by-count":5,"title":["Impact of Mineralocorticoid Receptor Antagonists in the Treatment of Heart Failure: Targeting the Heart Failure Cascade"],"prefix":"10.7759","author":[{"given":"Uday","family":"Jadhav","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiny","family":"Nair","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padhinhare","family":"Mohanan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay","family":"Chopra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prafulla","family":"Kerkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arup","family":"Das Biswas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakash K","family":"Hazra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitin","family":"Zalte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amarnath","family":"Sugumaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senthilnathan","family":"Mohanasundaram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s10389-019-01141-w","article-title":"Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry, India","volume":"29","author":"Singh A","year":"2021","unstructured":"Singh A, Chauhan S, Devasia T, et al.. Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry, India. J Public Health (Berl.). 2021, 29:585-94. 10.1007\/s10389-019-01141-w","journal-title":"J Public Health (Berl.)"},{"key":"ref2","article-title":"Heart failure: epidemiology and prevention in India","volume":"23","author":"Huffman MD","year":"2010","unstructured":"Huffman MD, Prabhakaran D. Heart failure: epidemiology and prevention in India. Natl Med J India. 2010, 23:283-8.","journal-title":"Natl Med J India"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2017.11.015","article-title":"Management protocols for chronic heart failure in India","volume":"70","author":"Mishra S","year":"2018","unstructured":"Mishra S, Mohan JC, Nair T, et al.. Management protocols for chronic heart failure in India. Indian Heart J. 2018, 70:105-27. 10.1016\/j.ihj.2017.11.015","journal-title":"Indian Heart J"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2011.11.007","article-title":"The pathophysiology of heart failure","volume":"21","author":"Kemp CD","year":"2012","unstructured":"Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol. 2012, 21:365-71. 10.1016\/j.carpath.2011.11.007","journal-title":"Cardiovasc Pathol"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1182","article-title":"Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry","volume":"20","author":"Savarese G","year":"2018","unstructured":"Savarese G, Carrero JJ, Pitt B, Anker SD, Rosano GM, Dahlstr\u00f6m U, Lund LH. Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry. Eur J Heart Fail. 2018, 20:1326-34. 10.1002\/ejhf.1182","journal-title":"Eur J Heart Fail"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijchv.2014.03.005","article-title":"Mineralocorticoid receptor antagonist in heart failure: past, present and future perspectives","volume":"3","author":"Vizzardi E","year":"2014","unstructured":"Vizzardi E, Regazzoni V, Caretta G, et al.. Mineralocorticoid receptor antagonist in heart failure: past, present and future perspectives. Int J Cardiol Heart Vessel. 2014, 3:6-14. 10.1016\/j.ijchv.2014.03.005","journal-title":"Int J Cardiol Heart Vessel"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1097\/med.0b013e3283391989","article-title":"Aldosterone and inflammation","volume":"17","author":"Gilbert KC","year":"2010","unstructured":"Gilbert KC, Brown NJ. Aldosterone and inflammation. Curr Opin Endocrinol Diabetes Obes. 2010, 17:199-204. 10.1097\/med.0b013e3283391989","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.110.164962","article-title":"The mineralocorticoid receptor in heart: different effects in different cells","volume":"57","author":"Jaisser F","year":"2011","unstructured":"Jaisser F, Swynghedauw B, Delcayre C. The mineralocorticoid receptor in heart: different effects in different cells. Hypertension. 2011, 57:679-80. 10.1161\/HYPERTENSIONAHA.110.164962","journal-title":"Hypertension"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01399-7","article-title":"Mineralocorticoid receptor antagonists: a comprehensive review of finerenone","volume":"22","author":"Rico-Mesa JS","year":"2020","unstructured":"Rico-Mesa JS, White A, Ahmadian-Tehrani A, Anderson AS. Mineralocorticoid receptor antagonists: a comprehensive review of finerenone. Curr Cardiol Rep. 2020, 22:140. 10.1007\/s11886-020-01399-7","journal-title":"Curr Cardiol Rep"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.302706","article-title":"Role of mineralocorticoid receptor antagonists in cardiovascular disease","volume":"116","author":"Ferrario CM","year":"2015","unstructured":"Ferrario CM, Schiffrin EL. Role of mineralocorticoid receptor antagonists in cardiovascular disease. Circ Res. 2015, 116:206-13. 10.1161\/CIRCRESAHA.116.302706","journal-title":"Circ Res"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.102.22.2700","article-title":"Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the randomized aldactone evaluation study (RALES). Rales Investigators","volume":"102","author":"Zannad F","year":"2000","unstructured":"Zannad F, Alla F, Dousset B, Perez A, Pitt B. Limitation of excessive extracellular matrix turnover may contribute to survival benefit of spironolactone therapy in patients with congestive heart failure: insights from the randomized aldactone evaluation study (RALES). Rales Investigators. Circulation. 2000, 102:2700-6. 10.1161\/01.cir.102.22.2700","journal-title":"Circulation"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.809194","article-title":"Extracellular cardiac matrix biomarkers in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) study","volume":"119","author":"Iraqi W","year":"2009","unstructured":"Iraqi W, Rossignol P, Angioi M, et al.. Extracellular cardiac matrix biomarkers in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) study. Circulation. 2009, 119:2471-9. 10.1161\/CIRCULATIONAHA.108.809194","journal-title":"Circulation"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-019-01500-3","article-title":"Determinants of anti-fibrotic response to mineralocorticoid receptor antagonist therapy: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) and Early Eplerenone Treatment in Patients with Acute ST-elevation Myocardial Infarction without Heart Failure (REMINDER) trials","volume":"109","author":"Stienen S","year":"2020","unstructured":"Stienen S, Rossignol P, Barros A, Girerd N, Pitt B, Zannad F, Ferreira JP. Determinants of anti-fibrotic response to mineralocorticoid receptor antagonist therapy: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) and Early Eplerenone Treatment in Patients with Acute ST-elevation Myocardial Infarction without Heart Failure (REMINDER) trials. Clin Res Cardiol. 2020, 109:194-204. 10.1007\/s00392-019-01500-3","journal-title":"Clin Res Cardiol"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(02)02382-3","article-title":"Belgian RALES investigators. Beneficial neurohormonal profile of spironolactone in severe congestive heart failure: results from the RALES neurohormonal substudy","volume":"40","author":"Rousseau MF","year":"2002","unstructured":"Rousseau MF, Gurn\u00e9 O, Duprez D, et al.. Belgian RALES investigators. Beneficial neurohormonal profile of spironolactone in severe congestive heart failure: results from the RALES neurohormonal substudy. J Am Coll Cardiol. 2002, 40:1596-601. 10.1016\/s0735-1097(02)02382-3","journal-title":"J Am Coll Cardiol"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.119.006638","article-title":"Mechanistic effects of spironolactone on cardiovascular and renal biomarkers in heart failure with preserved ejection fraction: A TOPCAT biorepository study","volume":"13","author":"Myhre PL","year":"2020","unstructured":"Myhre PL, Vaduganathan M, O'Meara E, et al.. Mechanistic effects of spironolactone on cardiovascular and renal biomarkers in heart failure with preserved ejection fraction: A TOPCAT biorepository study. Circ Heart Fail. 2020, 13:e006638. 10.1161\/CIRCHEARTFAILURE.119.006638","journal-title":"Circ Heart Fail"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators","volume":"341","author":"Pitt B","year":"1999","unstructured":"Pitt B, Zannad F, Remme WJ, et al.. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999, 341:709-17. 10.1056\/NEJM199909023411001","journal-title":"N Engl J Med"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2018.09.011","article-title":"Spironolactone and outcomes in older patients with heart failure and reduced ejection fraction","volume":"132","author":"Bayoumi E","year":"2019","unstructured":"Bayoumi E, Lam PH, Dooley DJ, et al.. Spironolactone and outcomes in older patients with heart failure and reduced ejection fraction. Am J Med. 2019, 132:71-80.e1. 10.1016\/j.amjmed.2018.09.011","journal-title":"Am J Med"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad F","year":"2011","unstructured":"Zannad F, McMurray JJ, Krum H, et al.. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011, 364:11-21. 10.1056\/NEJMoa1009492","journal-title":"N Engl J Med"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt B","year":"2003","unstructured":"Pitt B, Remme W, Zannad F, et al.. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003, 348:1309-21. 10.1056\/NEJMoa030207","journal-title":"N Engl J Med"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31829e8807","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"128","author":"Yancy CW","year":"2013","unstructured":"Yancy CW, Jessup M, Bozkurt B, et al.. 2013 ACCF\/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines. Circulation. 2013, 128:1810-52. 10.1161\/CIR.0b013e31829e8807","journal-title":"Circulation"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh TA","year":"2021","unstructured":"McDonagh TA, Metra M, Adamo M, et al.. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021, 42:3599-726. 10.1093\/eurheartj\/ehab368","journal-title":"Eur Heart J"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2022.02.010","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure","volume":"28","year":"2022","unstructured":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure. J Card Fail. 2022, 28.e1-e167. 10.1016\/j.cardfail.2022.02.010","journal-title":"J Card Fail"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12571","article-title":"Spironolactone use is associated with improved outcomes in heart failure with mid-range ejection fraction","volume":"7","author":"Enzan N","year":"2020","unstructured":"Enzan N, Matsushima S, Ide T, Kaku H, Higo T, Tsuchihashi-Makaya M, Tsutsui H. Spironolactone use is associated with improved outcomes in heart failure with mid-range ejection fraction. ESC Heart Fail. 2020, 7:339-47. 10.1002\/ehf2.12571","journal-title":"ESC Heart Fail"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv464","article-title":"Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction","volume":"37","author":"Solomon SD","year":"2016","unstructured":"Solomon SD, Claggett B, Lewis EF, et al.. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J. 2016, 37:455-62. 10.1093\/eurheartj\/ehv464","journal-title":"Eur Heart J"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1531","article-title":"Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Seferovic PM","year":"2019","unstructured":"Seferovic PM, Ponikowski P, Anker SD, et al.. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019, 21:1169-86. 10.1002\/ejhf.1531","journal-title":"Eur J Heart Fail"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2010.0841","article-title":"Treatment of heart failure with preserved ejection fraction: have we been pursuing the wrong paradigm?","volume":"86","author":"Oghlakian GO","year":"2011","unstructured":"Oghlakian GO, Sipahi I, Fang JC. Treatment of heart failure with preserved ejection fraction: have we been pursuing the wrong paradigm?. Mayo Clin Proc. 2011, 86:531-9. 10.4065\/mcp.2010.0841","journal-title":"Mayo Clin Proc"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731","article-title":"Spironolactone for heart failure with preserved ejection fraction","volume":"370","author":"Pitt B","year":"2014","unstructured":"Pitt B, Pfeffer MA, Assmann SF, et al.. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014, 370:1383-92. 10.1056\/NEJMoa1313731","journal-title":"N Engl J Med"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1177\/1470320313482603","article-title":"Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure","volume":"16","author":"Rossi R","year":"2015","unstructured":"Rossi R, Crupi N, Coppi F, Monopoli D, Sgura F. Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure. J Renin Angiotensin Aldosterone Syst. 2015, 16:119-25. 10.1177\/1470320313482603","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv273","article-title":"Clinical benefits of eplerenone in patients with systolic heart failure and mild symptoms when initiated shortly after hospital discharge: analysis from the EMPHASIS-HF trial","volume":"36","author":"Girerd N","year":"2015","unstructured":"Girerd N, Collier T, Pocock S, et al.. Clinical benefits of eplerenone in patients with systolic heart failure and mild symptoms when initiated shortly after hospital discharge: analysis from the EMPHASIS-HF trial. Eur Heart J. 2015, 36:2310-7. 10.1093\/eurheartj\/ehv273","journal-title":"Eur Heart J"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.5892","article-title":"Association of mineralocorticoid receptor antagonist use with all-cause mortality and hospital readmission in older adults with acute decompensated heart failure","volume":"2","author":"Yaku H","year":"2019","unstructured":"Yaku H, Kato T, Morimoto T, et al.. Association of mineralocorticoid receptor antagonist use with all-cause mortality and hospital readmission in older adults with acute decompensated heart failure. JAMA Netw Open. 2019, 2:e195892. 10.1001\/jamanetworkopen.2019.5892","journal-title":"JAMA Netw Open"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013267","article-title":"Effects of mineralocorticoid receptor antagonists on atrial fibrillation occurrence: a systematic review, meta-analysis, and meta-regression to identify modifying factors","volume":"8","author":"Alexandre J","year":"2019","unstructured":"Alexandre J, Dolladille C, Douesnel L, et al.. Effects of mineralocorticoid receptor antagonists on atrial fibrillation occurrence: a systematic review, meta-analysis, and meta-regression to identify modifying factors. J Am Heart Assoc. 2019, 8:e013267. 10.1161\/JAHA.119.013267","journal-title":"J Am Heart Assoc"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.895235","article-title":"Aldosterone receptor antagonists: effective but often forgotten","volume":"121","author":"Maron BA","year":"2010","unstructured":"Maron BA, Leopold JA. Aldosterone receptor antagonists: effective but often forgotten. Circulation. 2010, 121:934-9. 10.1161\/CIRCULATIONAHA.109.895235","journal-title":"Circulation"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20324","article-title":"A comparison of the aldosterone-blocking agents eplerenone and spironolactone","volume":"31","author":"Struthers A","year":"2008","unstructured":"Struthers A, Krum H, Williams GH. A comparison of the aldosterone-blocking agents eplerenone and spironolactone. Clin Cardiol. 2008, 31:153-8. 10.1002\/clc.20324","journal-title":"Clin Cardiol"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000792","article-title":"Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)","volume":"7","author":"Rossignol P","year":"2014","unstructured":"Rossignol P, Dobre D, McMurray JJ, et al.. Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circ Heart Fail. 2014, 7:51-8. 10.1161\/CIRCHEARTFAILURE.113.000792","journal-title":"Circ Heart Fail"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.021","article-title":"Abnormalities of potassium in heart failure: JACC state-of-the-art review","volume":"75","author":"Ferreira JP","year":"2020","unstructured":"Ferreira JP, Butler J, Rossignol P, et al.. Abnormalities of potassium in heart failure: JACC state-of-the-art review. J Am Coll Cardiol. 2020, 75:2836-50. 10.1016\/j.jacc.2020.04.021","journal-title":"J Am Coll Cardiol"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/144164-impact-of-mineralocorticoid-receptor-antagonists-in-the-treatment-of-heart-failure-targeting-the-heart-failure-cascade","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,9]],"date-time":"2024-02-09T20:04:48Z","timestamp":1707509088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/144164-impact-of-mineralocorticoid-receptor-antagonists-in-the-treatment-of-heart-failure-targeting-the-heart-failure-cascade"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,14]]},"references-count":35,"URL":"https:\/\/doi.org\/10.7759\/cureus.45241","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9,14]]}}}