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首页> 外文期刊>Journal of Clinical Medicine Research >The Impact Exerted on Clinical Outcomes of Patients With Chronic Heart Failure by Aldosterone Receptor Antagonists: A Meta-Analysis of Randomized Controlled Trials
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The Impact Exerted on Clinical Outcomes of Patients With Chronic Heart Failure by Aldosterone Receptor Antagonists: A Meta-Analysis of Randomized Controlled Trials

机译：醛固酮受体拮抗剂对慢性心力衰竭患者临床结果的影响：一项随机对照试验的荟萃分析

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Background: Aldosterone receptor antagonists (ARAs) have been associated with improved clinical outcomes in patients with heart failure with reduced left ventricular ejection fraction (HFREF), but not in those with heart failure with preserved left ventricular ejection fraction (HFpEF). With the aim to study this topic more deeply, we carried out a meta-analysis of selective and non-selective ARAs in HFREF and HFpEF.Methods: We searched PubMed and Scopus databases. We decided to incorporate in the meta-analysis only randomized controlled trials (RCTs) of ARAs in patients with chronic heart failure (CHF) if they met the following criteria: experimental groups included patients with CHF treated with ARAs in addition to the conventional therapy; control groups included patients with CHF receiving conventional therapy without ARAs. Outcomes of interest were all-cause death, hospitalizations from cardiovascular cause, hyperkalemia, or gynecomastia.Results: We detected 15 studies representing 15,671 patients. ARAs were associated with a reduced odds of all-cause death (odds ratio (OR): 0.79; 95% confidence interval (CI): 0.73 - 0.87) and hospitalizations from cardiovascular cause (OR: 0.73; 95% CI: 0.61 - 0.89). However, subgroup analysis showed that these advantages were limited to HFREF (all-cause death: OR: 0.77, 95% CI: 0.69 - 0.84; hospitalizations from cardiovascular cause: OR: 0.66, 95% CI: 0.51 - 0.85), but they did not affect the HFpEF group (all-cause death: OR: 0.91, 95% CI: 0.76 - 1.1; hospitalizations from cardiovascular cause: OR: 0.85, 95% CI: 0.7 - 1.09). ARAs increased the risk of hyperkalemia (OR: 2.17; 95% CI: 1.88 - 2.5). Non-selective ARAs, but not selective ARAs, increased the risk of gynecomastia (OR: 8.22, 95% CI: 4.9 - 13.81 vs. OR: 0.74, 95% CI: 0.43 - 1.27).Conclusions: ARAs reduced the risk of adverse cardiac events in HFREF but not HFpEF. In particular, ARA use in HFpEF patients is questionable, since in this CHF type, no significant improvement in all-cause death and cardiovascular hospitalizations was demonstrated with ARA treatment, in the face of the well-known risks of hyperkalemia and/or gynecomastia that chronic ARA therapy entails. Selective ARAs were equally effective as non-selective ARAs, without the risk of gynecomastia.J Clin Med Res. 2017;9(2):130-142doi: https://doi.org/10.14740/jocmr2851w
机译：背景：醛固酮受体拮抗剂（ARAs）与心力衰竭患者左室射血分数（HFREF）降低的临床效果改善相关，但与左心室射血分数保留（HFpEF）的心力衰竭患者无关。为了更深入地研究该主题，我们对HFREF和HFpEF中的选择性和非选择性ARAs进行了荟萃分析。方法：搜索PubMed和Scopus数据库。如果符合以下标准，我们决定仅将ARAs纳入慢性心力衰竭（CHF）患者的随机对照试验（RCT）中纳入荟萃分析：实验组除常规治疗外还包括接受ARAs治疗的CHF患者。对照组包括接受无ARAs常规治疗的CHF患者。感兴趣的结果是全因死亡，因心血管原因住院，高钾血症或男性乳房发育症。结果：我们检测到15项研究，代表15671例患者。 ARA与全因死亡几率降低（几率（OR）：0.79; 95％置信区间（CI）：0.73-0.87）和因心血管原因而住院（OR：0.73; 95％CI：0.61-0.89） ）。但是，亚组分析表明，这些优势仅限于HFREF（全因死亡：OR：0.77，95％CI：0.69-0.84;因心血管原因住院：OR：0.66，95％CI：0.51-0.85），但它们并未影响HFpEF组（全因死亡：OR：0.91，95％CI：0.76-1.1;心血管原因住院：OR：0.85，95％CI：0.7-1.09）。 ARAs增加了高钾血症的风险（OR：2.17; 95％CI：1.88-2.5）。非选择性ARAs而非选择性ARAs会增加女性乳房发育的风险（OR：8.22，95％CI：4.9-13.81 vs. OR：0.74，95％CI：0.43-1.27）。结论：ARAs降低了不良反应的风险。 HFREF而非HFpEF引起的心脏事件。特别是，在HFpEF患者中使用ARA值得怀疑，因为在这种CHF类型中，面对众所周知的高钾血症和/或男性乳房发育风险，使用ARA治疗并不能证明全因死亡和心血管疾病住院的显着改善。慢性ARA治疗需要进行。选择性ARAs与非选择性ARAs一样有效，并且没有男性乳房发育的风险。 2017; 9（2）：130-142doi：https://doi.org/10.14740/jocmr2851w

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