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Mineralocorticoid receptor overactivation: targeting systemic impact with non‑steroidal mineralocorticoid receptor antagonists – published online 21/12/2023

Savarese graphical abstract

Gianluigi Savarese, Felix Lindberg, Gerasimos Filippatos, Javed Butler, Stefan D. Anker

Overactivation of the mineralocorticoid receptor (MR) has pathophysiological implications in multiple organ systems. In this issue, Savarese and Lindberg et al (https://doi.org/10.1007/s00125-023-06031-1) provide a comprehensive review of the role of MR overactivation in cardiac and renal disease, and summarise the evidence related to old and new methods of pharmacologically targeting the MR. The authors describe how traditional steroidal MR antagonists (MRA) are a cornerstone of therapy in heart failure but remain underused due to real and perceived risks of side effects, particularly in patients with renal failure and/or at risk of hyperkalaemia. Novel non-steroidal MRA have distinct properties that might enable inhibition of the MR with an improved safety profile. The authors highlight how the Phase III programme on one such novel non-steroidal MRA, finerenone, demonstrated improved renal and cardiovascular outcomes in patients with diabetic kidney disease, potentially setting the stage for a new paradigm in targeting MR overactivation. The figures from this review are available as a downloadable slideset.

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