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

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Cleland, JGF (Author) Other; Ferreira, JP (Author) FMUP; Mariottoni, B (Author) Other; Pellicori, P (Author) Other; Cuthbert, J (Author) Other; Verdonschot, JAJ (Author) Other; Petutschnigg, J (Author) Other; Ahmed, FZ (Author) Other; Cosmi, F (Author) Other; Brunner La Rocca, H (Author) Other; Mamas, MA (Author) Other; Clark, AL (Author) Other; Edelmann, F (Author) Other; Pieske, B (Author) Other; Khan, J (Author) Other; McDonald, K (Author) Other; Rouet, P (Author) Other; Staessen, JA (Author) Other; Mujaj, B (Author) Other; González, A (Author) Other; Diez, J (Author) Other; Hazebroek, M (Author) Other; Heymans, S (Author) Other; Latini, R (Author) Other; Grojean, S (Author) Other; Pizard, A (Author) Other; Girerd, N (Author) Other; Rossignol, P (Author) Other; Collier, TJ (Author) Other; Zannad, F (Author) Other; Atar, D (Author) Other; Kober, L (Author) Other; Dickstein, K (Author) Other; Lange, T (Author) Other

Journal

Title: European Heart Journal

Vol. 42

Pages: 684-696

ISSN: 0195-668X

Publisher: Oxford University Press

Other information

Authenticus ID: P-00V-8QF

DOI: 10.1093/eurheartj/ehaa758

Abstract (EN): <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims¿</jats:title> <jats:p>To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results¿</jats:title> <jats:p>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¿¿g/L; P¿=¿0.32] but those receiving spironolactone had greater reductions in PICP (mdiff: ¿8.1; 95% CI ¿11.9 to ¿4.3¿¿g/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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions¿</jats:title> <jats:p>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.</jats:p> <jats:p ></jats:p> </jats:sec>

Language: English

Type (Professor's evaluation): Dissemination