Written by Babatunde Carew
Spoon Feed
Finerenone reduces cardiovascular events in HFmrEF/HFpEF patients across BMI categories, with potentially greater benefits at higher BMIs.
Finerenone weighs in, but is it a contender in HF?
- The FINEARTS-HF trial showed that finerenone (a non-steroidal mineralocorticoid antagonist, MRA) reduced a composite outcome of worsening heart failure events and cardiovascular death in HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), but did not improve cardiovascular mortality.
- Studies have suggested that obesity increases aldosterone production; therefore, MRAs may have greater benefit in HF patients with co-existing obesity.
- This prespecified analysis of the FINEARTS-HF trial evaluated finerenone in 6,001 patients with HFmrEF/MFpEF across BMI categories. The study revealed greater efficacy in reducing a composite of cardiovascular death and HF events in patients with a higher BMI (obesity class II/III, RR 0.67, 95%CI 0.50–0.89) compared to all other BMI groups. [AI generated, physician edited]
- The greater benefit in the higher BMI group was not maintained when the study population was grouped by other measures of adiposity, such as waist-to-height ratio.
How does this change my practice?
This study does not change my current practice. The degree of efficacy of finerenone was inconsistent across different measures of adiposity, suggesting that there may not truly be an increased benefit in patients with HFmrEF/HFpEF based on weight. Further, finerenone remains much more expensive than other MRAs on the market, making it difficult to justify its use in the absence of studies demonstrating clear superiority over agents such as spironolactone.
Source
Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction: Prespecified Analysis of FINEARTS-HF. J Am Coll Cardiol. 2025 Jan 21;85(2):140-155. doi: 10.1016/j.jacc.2024.10.111. Epub 2024 Dec 10. PMID: 39665701
