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.
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.
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DOI：
10.1093/eurheartj/ehaa758
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发表时间：
2021-02-11
影响因子：
39.3
通讯作者：
HOMAGE Trial Committees and Investigators
中科院分区：
文献类型：
--
作者：
Cleland JGF;Ferreira JP;Mariottoni B;Pellicori P;Cuthbert J;Verdonschot JAJ;Petutschnigg J;Ahmed FZ;Cosmi F;Brunner La Rocca HP;Mamas MA;Clark AL;Edelmann F;Pieske B;Khan J;McDonald K;Rouet P;Staessen JA;Mujaj B;González A;Diez J;Hazebroek M;Heymans S;Latini R;Grojean S;Pizard A;Girerd N;Rossignol P;Collier TJ;Zannad F;HOMAGE Trial Committees and Investigators
研究螺内酯对心力衰竭风险增加人群的纤维化和心功能的影响。一项随机、开放标签、盲法终点试验，比较螺内酯（50 mg/天）或对照组在冠心病或冠心病高危人群中持续9个月，血浆B型利钠肽升高。主要终点是基线血清半乳糖凝集素-3和血清III型前胶原N-末端前肽（PIIINP）变化之间的相互作用。还测量了反映I型胶原的合成和降解的I型前胶原C-末端前肽（PICP）和I型胶原C-末端肽（CITP）。527名参与者（中位年龄73岁，26%为女性），螺内酯组和对照组的PIIINP变化相似[平均差异（mdiff）：-0.15; 95%置信区间（CI）：-0.44至0.15 μg/L; P = 0.32]，但接受螺内酯的患者PICP降低幅度更大（mdiff：−8.1; 95%CI −11.9至−4.3 μg/L; P < 0.0001）和PICP/CITP比值（mdiff：−2.9; 95%CI −4.3至−1.5; <0.0001）。未观察到与血清半乳糖凝集素的相互作用。在接受螺内酯治疗的患者中，收缩压（mdiff：−10; 95% CI −13至−7 mmHg; P < 0.0001）、左心房容积（mdiff：−1; 95% CI −2至0 mL/m2; P = 0.010）和NT-proBNP（mdiff：−57; 95% CI −81至−33 ng/L; P < 0.0001）均降低。半乳糖凝集素-3没有发现响应于螺内酯的胶原蛋白生物标志物的血清浓度的更大降低。然而，螺内酯可能影响I型胶原代谢。螺内酯是否能延缓或预防症状性心力衰竭的进展，还需进一步研究。
To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure. 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. 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.
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影响因子：
18.2
作者：
Edelmann, Frank;Holzendorf, Volker;Pieske, Burkert M.
通讯作者：
Pieske, Burkert M.
影响因子：
120.7
作者：
Edelmann, Frank;Wachter, Rolf;Pieske, Burkert
通讯作者：
Pieske, Burkert
影响因子：
14
作者：
Kosmala, Wojciech;Przewlocka-Kosmala, Monika;Marwick, Thomas H.
通讯作者：
Marwick, Thomas H.
影响因子：
37.8
作者：
Izawa, H;Murohara, T;Yokota, M
通讯作者：
Yokota, M
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick