Effect of Mineralocorticoid receptor antagonism (MRA) on aldosterone-interleukin 6 axis in heart failure; second opinion. A case-control study

Abstract

Background In cases of heart failure characterized by reduced ejection fraction (HFrEF), heightened levels of aldosterone negatively impact the progression of heart failure. Aldosterone exerts its influence through the activation of mineralocorticoid receptors, leading to the subsequent release of IL-6. Recently, the discovery of the role of mineralocorticoid receptor antagonism (MRA) in managing the progression of heart failure, particularly through its effect on IL-6, prompted its inclusion in the American College of Cardiology guidelines. In the years 2019 and 2021, studies elucidated the proinflammatory role of interleukin 6 in the cytokine storm associated with COVID-19, emphasizing the significance of IL-6 inhibitors in controlling this storm. Further research is required to examine the impact of mineralocorticoid receptor antagonism (MRA) on both aldosterone levels and IL-6 release in patients with HFrEF. Additionally, there is a need to assess the effectiveness of current MRA dosages in controlling heart failure with reduced ejection fraction. Patients and methods A retrospective analysis was conducted on 108 patients with HFrEF diagnosed through echocardiography. The study covered the period from December 2021 to December 2022. All participants underwent blood tests for aldosterone and interleukin 6 using the ELISA test. The patients were categorized based on cardiac compensation status and the specific mineralocorticoid receptor antagonist (MRA) drug regimen they were on. Results There was a notable rise in aldosterone levels and a reduction in serum IL6 observed in 30 patients with Acute Decompensated Heart Failure (ADHF) who were treated with Mineralocorticoid Receptor Antagonists (MRA), as compared to 30 patients with a similar diagnosis who did not receive MRA. Among 24 patients with compensated heart failure using MRA, there was a significant increase in aldosterone levels and a decrease in IL6, in contrast to 24 patients with compensated heart failure who were not on MRA therapy. Conclusions In heart failure with reduced ejection fraction (HFrEF), inhibiting mineralocorticoid receptors leads to a reduction in pro-inflammatory IL-6. The action of Mineralocorticoid Receptor Antagonists (MRA) is deemed safe, well-tolerated, and cost-effective when compared to IL-6 inhibitors. There is a need to reevaluate the current MRA regimen with the objective of enhancing its efficacy for optimal reduction in IL-6 and effective control of heart failure progression.