The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.

中文翻译：

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盐皮质激素拮抗剂在心力衰竭中的作用：既定和新兴的治疗作用


心力衰竭（HF）的病理生理学与盐皮质激素受体的过度激活有关，导致液体潴留和不良心肌重塑。尽管盐皮质激素受体拮抗剂（MRA）被推荐用于治疗射血分数降低的心力衰竭（HFrEF），但由于高钾血症等不良反应，它们仍未得到充分利用。它们对于射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）的疗效存在争议。最近在糖尿病和肾病患者中进行的试验支持使用非类固醇 MRA 来降低心力衰竭相关的发病率和死亡率，并且副作用比类固醇同类药物更少。非类固醇 MRA 的有效性和安全性尚未在心力衰竭中进行测试，目前正在其他临床试验中进行评估。本综述全面审查了有关心衰 MRA 的当前数据和非甾体 MRA 研究的未来方向，同时探讨了 MRA 未充分利用的原因。