Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors
Background Mineralocorticoid receptor antagonists (MRAs) have emerged as potential atrial fibrillation (AF) preventive therapy, but inconsistent results have been reported. We aimed to examine the effects of MRAs on AF occurrence and explore factors that could influence the magnitude of the effect s...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013267 |
| _version_ | 1811275120454402048 |
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| author | Joachim Alexandre Charles Dolladille Laurent Douesnel Jonaz Font Rafal Dabrowski Linda Shavit Damien Legallois Christian Funck‐Brentano Laure Champ‐Rigot Pierre Ollitrault Farzin Beygui Theodora Bejan‐Angoulvant Jean‐Jacques Parienti Paul Milliez |
| author_facet | Joachim Alexandre Charles Dolladille Laurent Douesnel Jonaz Font Rafal Dabrowski Linda Shavit Damien Legallois Christian Funck‐Brentano Laure Champ‐Rigot Pierre Ollitrault Farzin Beygui Theodora Bejan‐Angoulvant Jean‐Jacques Parienti Paul Milliez |
| author_sort | Joachim Alexandre |
| collection | DOAJ |
| description | Background Mineralocorticoid receptor antagonists (MRAs) have emerged as potential atrial fibrillation (AF) preventive therapy, but inconsistent results have been reported. We aimed to examine the effects of MRAs on AF occurrence and explore factors that could influence the magnitude of the effect size. Methods and Results PubMed, Embase, and Cochrane Central databases were used to search for randomized clinical trials and observational studies addressing the effect of MRAs on AF occurrence from database inception through April 03, 2018. We performed a systematic review and random effects meta‐analyses to compute odds ratios with 95% CIs. Meta‐regression was then applied to explore the sources of between‐study heterogeneity. We included 24 studies, 11 randomized clinical trials and 13 observational cohorts, representing a total number of 7914 patients (median age: 64.2 years; median left ventricular ejection fraction: 49.7%; median follow‐up: 12.0 months), 2843 (35.9%) of whom received MRA therapy. Meta‐analyses showed a significant overall reduction in AF occurrence in the MRA‐treated patients versus the control groups (15.0% versus 32.2%; odds ratio, 0.55; 95% CI, 0.44–0.70 [P<0.00001]), with the greatest benefit regarding recurrent AF episodes (odds ratio, 0.42; 95% CI, 0.31–0.59 [P<0.00001]) and with significant heterogeneity among the included studies (I2=54%; P=0.0008). Meta‐regression analyses showed that effect size was significantly associated with older studies and higher AF occurrence rate in the control groups. Conclusions MRAs seem to be effective in AF prevention, especially regarding recurrent AF episodes. |
| first_indexed | 2024-04-12T23:32:25Z |
| format | Article |
| id | doaj.art-40a655bdaaf649b68dff766435a14605 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:32:25Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-40a655bdaaf649b68dff766435a146052022-12-22T03:12:14ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182210.1161/JAHA.119.013267Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying FactorsJoachim Alexandre0Charles Dolladille1Laurent Douesnel2Jonaz Font3Rafal Dabrowski4Linda Shavit5Damien Legallois6Christian Funck‐Brentano7Laure Champ‐Rigot8Pierre Ollitrault9Farzin Beygui10Theodora Bejan‐Angoulvant11Jean‐Jacques Parienti12Paul Milliez13Department of Pharmacology CHU Caen FranceDepartment of Pharmacology CHU Caen FranceDepartment of Pharmacology CHU Caen FranceDepartment of Pharmacology CHU Caen FranceInstitute of Cardiology Warsaw PolandAdult Nephrology Unit Shaare Zedek Medical Center Jerusalem IsraelUNICAEN, CHU Caen Medical School Université Caen Normandie Caen FranceDepartment of Pharmacology AP‐HP Pitié‐Salpêtrière Hospital Paris FranceUNICAEN, CHU Caen Medical School Université Caen Normandie Caen FranceDepartment of Cardiology CHU Caen FranceUNICAEN, CHU Caen Medical School Université Caen Normandie Caen FrancePharmacology Department CHRU Tours FranceDepartment of Biostatistics and Clinical Research CHU Caen FranceUNICAEN, CHU Caen Medical School Université Caen Normandie Caen FranceBackground Mineralocorticoid receptor antagonists (MRAs) have emerged as potential atrial fibrillation (AF) preventive therapy, but inconsistent results have been reported. We aimed to examine the effects of MRAs on AF occurrence and explore factors that could influence the magnitude of the effect size. Methods and Results PubMed, Embase, and Cochrane Central databases were used to search for randomized clinical trials and observational studies addressing the effect of MRAs on AF occurrence from database inception through April 03, 2018. We performed a systematic review and random effects meta‐analyses to compute odds ratios with 95% CIs. Meta‐regression was then applied to explore the sources of between‐study heterogeneity. We included 24 studies, 11 randomized clinical trials and 13 observational cohorts, representing a total number of 7914 patients (median age: 64.2 years; median left ventricular ejection fraction: 49.7%; median follow‐up: 12.0 months), 2843 (35.9%) of whom received MRA therapy. Meta‐analyses showed a significant overall reduction in AF occurrence in the MRA‐treated patients versus the control groups (15.0% versus 32.2%; odds ratio, 0.55; 95% CI, 0.44–0.70 [P<0.00001]), with the greatest benefit regarding recurrent AF episodes (odds ratio, 0.42; 95% CI, 0.31–0.59 [P<0.00001]) and with significant heterogeneity among the included studies (I2=54%; P=0.0008). Meta‐regression analyses showed that effect size was significantly associated with older studies and higher AF occurrence rate in the control groups. Conclusions MRAs seem to be effective in AF prevention, especially regarding recurrent AF episodes.https://www.ahajournals.org/doi/10.1161/JAHA.119.013267aldosterone, mineralocorticoidsatrial fibrillationmeta‐analysis |
| spellingShingle | Joachim Alexandre Charles Dolladille Laurent Douesnel Jonaz Font Rafal Dabrowski Linda Shavit Damien Legallois Christian Funck‐Brentano Laure Champ‐Rigot Pierre Ollitrault Farzin Beygui Theodora Bejan‐Angoulvant Jean‐Jacques Parienti Paul Milliez Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aldosterone, mineralocorticoids atrial fibrillation meta‐analysis |
| title | Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors |
| title_full | Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors |
| title_fullStr | Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors |
| title_full_unstemmed | Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors |
| title_short | Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta‐Analysis, and Meta‐Regression to Identify Modifying Factors |
| title_sort | effects of mineralocorticoid receptor antagonists on atrial fibrillation occurrence a systematic review meta analysis and meta regression to identify modifying factors |
| topic | aldosterone, mineralocorticoids atrial fibrillation meta‐analysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013267 |
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