The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the heart 'OMics' in AGEing (HOMAGE) randomized clinical trial.
Eur Heart J
; 42(6): 684-696, 2021 02 11.
Article
em En
| MEDLINE
| ID: mdl-33215209
ABSTRACT
AIMS:
To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure. METHODS ANDRESULTS:
Randomized, open-label, blinded-endpoint trial comparing spironolactone (50 mg/day) or control for up to 9 months in people with, or at high risk of, coronary disease and raised plasma B-type natriuretic peptides. The primary endpoint was the interaction between baseline serum galectin-3 and changes in serum procollagen type-III N-terminal pro-peptide (PIIINP) in participants assigned to spironolactone or control. Procollagen type-I C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), reflecting synthesis and degradation of type-I collagen, were also measured. In 527 participants (median age 73 years, 26% women), changes in PIIINP were similar for spironolactone and control [mean difference (mdiff) -0.15; 95% confidence interval (CI) -0.44 to 0.15 µg/L; P = 0.32] but those receiving spironolactone had greater reductions in PICP (mdiff -8.1; 95% CI -11.9 to -4.3 µg/L; P < 0.0001) and PICP/CITP ratio (mdiff -2.9; 95% CI -4.3 to -1.5; <0.0001). No interactions with serum galectin were observed. Systolic blood pressure (mdiff -10; 95% CI -13 to -7 mmHg; P < 0.0001), left atrial volume (mdiff -1; 95% CI -2 to 0 mL/m2; P = 0.010), and NT-proBNP (mdiff -57; 95% CI -81 to -33 ng/L; P < 0.0001) were reduced in those assigned spironolactone.CONCLUSIONS:
Galectin-3 did not identify greater reductions in serum concentrations of collagen biomarkers in response to spironolactone. However, spironolactone may influence type-I collagen metabolism. Whether spironolactone can delay or prevent progression to symptomatic heart failure should be investigated.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Espironolactona
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Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Eur Heart J
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido