The use of a novel non-steroidal mineralocorticoid receptor antagonist finerenone for the treatment of chronic heart failure: A systematic review and meta-analysis.

BACKGROUND: The non-steroidal mineralocorticoid receptor antagonist finerenone (BAY 94-8862) has been used to treat chronic heart failure (CHF) with reduced ejection fraction (HFrEF). However, conflicting results were reported for its efficacy and safety. The study aimed to compare the efficacy and safety of finerenone versus spironolactone or eplerenone in patients with chronic heart failure. METHODS: Electronic databases including MEDLINE, EMBASE, and CENTRAL were searched from inception to December 2017 for randomized controlled trials assessing finerenone treatment in patients with chronic heart failure. Data concerning the study's design, patients' characteristics, and outcomes were extracted. Risk ratio (RR) and mean differences (MD) were calculated using either fixed or random effects models. RESULTS: Three trials with 1520 CHF patients were included in the systematic review. In terms of anti-ventricular remodeling, we calculated the effective number of cases with a 30% reduction in NT-proBNP. Finerenone was equivalent to the existing steroidal mineralocorticoid antagonist (P < .05). However, the efficacy of finerenone appeared to be dose-dependent. At a dose of 10 mg/d finerenone was found to be marginally better than that of steroidal mineralocorticoid receptor antagonists (MRAs) (RR = 1.18, 95% confidence interval [CI] 0.88, 1.57, P > .05). The incidence of treatment-related adverse events (TEAEs) of finerenone at 10 mg/d was significantly lower than 25 to 50 mg/d of steroidal MRAs (RR = 0.81, 95% CI = 0.66-0.99, P = .04). Moreover, the serum potassium levels in the finerenone 10 mg/d group were lower than those in the 25 to 50 mg/d steroidal MRAs group (MD = -0.14, 95% CI -0.30-0.02, P = .09), whereas the estimated glomerular filtration rate (eGFR) was higher in finerenone versus steroidal MRAs treated patients (MD = 2.07, 95% CI -0.04-4.17, P = .05). CONCLUSIONS: Finerenone reduced NT-proBNP level, urinary albumin/creatinine ratio (UACR), and other biochemical indicators, in a dose-dependent manner. In terms of anti-ventricular remodeling in patient with chronic heart failure, finerenone at 10 mg/d is as effective as 20 to 50 mg/d of steroidal MRAs. However, finerenone is much safer to patients with chronic kidney disease.

Patchouli alcohol attenuates experimental atherosclerosis via inhibiting macrophage infiltration and its inflammatory responses.

Patchouli alcohol (PA) is a tricyclic sesquiterpene extracted from a traditional Chinese herb pogostemonis herba. Literatures have proven that PA could inhibit inflammatory responses in various inflammatory disease models. However, whether PA could protect against atherosclerosis, a chronic vascular inflammation, is unknown. In this study, we sought to explore this issue in atherosclerosis-prone apolipoprotein E knockout mice fed an atherogenic diet, with or without daily PA intragastrical administration (40mg/kg). Our results showed that PA administration did not change plasma lipids metabolism, however, it significantly attenuated atherosclerotic plaque burdens in both the aorta and the aortic root. The lesional macrophage content, shown as Mac2 positive areas, was reduced, while the lesional smooth muscle cell and collagen content, shown as α-SMA positive areas and by Sirius red staining, respectively, was not affected in PA-treated mice, compared with non-treated controls. Aortic mRNA expression of macrophage inflammatory cytokines, including MCP-1, iNOS, IL-1ß, IL-6, CXCL9 and CXCL11, was also reduced in PA-treated mice. Therefore, we demonstrated that PA could attenuate atherosclerosis, possibly by inhibiting macrophage infiltration and its inflammatory responses.

[Effect of shenfu injection on brain natriuretic polypeptide and aminoterminal peptide of precollagen type III in patients with acute myocardial infarction during intervention treatment].

OBJECTIVE: To investigate the effect of Shenfu injection (SFI) on indexes of heart function and myocardial fibrosis in patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI). METHODS: Ninety-three AMI patients treated by PCI were randomly divided into two groups, 47 in the treatment group (treated by PCI plus 40 ml SFI intravenous injection, once a day for 7 days) and 46 in the control group (treated by PCI only). Levels of brain natriuretic poly peptide (BNP) and aminoterminal peptide of precollagen type III (NP III) were measured at different time points, i.e. immediately after admission (T1), and at 24th hour (T2) and 7th day (T3) after AMI onset in the two groups. RESULTS: The proportion of TIMI 3 grade of front blood flow in AMI related vessels after PCI was insignificantly different in the two groups. The concentration of BNP of T2 was significantly higher than that of T1 in the two groups (P < 0.01), and it was higher in the control group than that in the treatment group (P < 0.01), while at T3, it was insignificantly different in the treatment group to that of T1 (P > 0.05), but in the control group, it was still significantly higher than that in the treatment group and that of T1 (P < 0.01). The levels of NP III the two groups were similar at T1 and T2 (P > 0.05). At T3, it showed an increase in the treatment group, but with no significant difference (P > 0.05) as compared with that at T1, but in the control group did markedly increase and showed significant difference as compared with that of T1 and that in the treatment group at T3 (P < 0.05). CONCLUSION: Early applying of SFI can protect myocardium from ischemia/reperfusion injury after AMI, ameliorate the degree of injury, improve heart function of patients and prevent myocardial fibrosis.