{"id":"628ff98a1875","type":"article","url":"https://hartvaat.nl/2024/03/07/mra-s-verminderen-af-risico-meta-analyse-van-klinische-trials/","title":"MRA's verminderen AF-risico: meta-analyse van klinische trials","title_en":"Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["abelacimab","aperitif-trial","colcot-trial","farmaco-economie","finerenon","finerenon-hartfalen-nierziekte","mra-aldosteronantagonisten","rivaroxaban"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad811","source_url":"https://doi.org/10.1093/eurheartj/ehad811","authors":["Alireza Oraii","Jeff S Healey","Krzysztof Kowalik","Avinash K Pandey","Alexander P Benz","Jorge A Wong","David Conen","William F McIntyre"],"significance":7,"published":"2024-03-07","source_date":"2024-03-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis of clinical trials showed that mineralocorticoid receptor antagonists reduce the risk of atrial fibrillation in heart failure patients, suggesting that the antifibrotic and anti-remodeling effects of MRAs extend to the atrial substrate.","created":"2026-07-03T10:30:49Z","updated":"2026-07-03T13:29:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat mineralocorticoïdreceptorantagonisten het risico op AF verminderen bij hartfalenpatiënten. Het anti-fibrotische effect van MRA's draagt bij aan atriale substraatverbetering en ritmecontrole.","abstract_original":"BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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): 0.67-0.98] and without HF (risk ratio = 0.84; 95% CI: 0.75-0.93; interaction P = .77). Among patients with HF, MRAs reduced cardiovascular death or HF hospitalization in patients with AF (hazard ratio = 0.95; 95% CI: 0.54-1.66) to a similar extent as in those without AF (hazard ratio = 0.82; 95% CI: 0.63-1.07; 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: 0.67-0.87) in both patients with and without prior AF. CONCLUSIONS: 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."}