Mineralocorticoid receptor antagonists in patients with transthyretin amyloid cardiomyopathy receiving disease-modifying therapy.

Authors

Kuan-Yu Chi, Anita Osabutey, Pei-Lun Lee, Ishmum Chowdhury, Ahmed Ashraf Morgan, Dimitrios Varrias, Robert T Faillace, Ulrich P Jorde, Yu Chang, Omar Saeed, Snehal R Patel

Published in

Heart (British Cardiac Society). Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Whether mineralocorticoid receptor antagonists (MRAs) confer incremental clinical benefit in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) treated with disease-modifying therapy remains uncertain. We aimed to assess the effectiveness and safety of MRAs in patients with ATTR-CM receiving disease-modifying therapy.
This retrospective cohort study used data from the TriNetX US database to identify adult patients with ATTR-CM who initiated disease-modifying therapy (tafamidis or vutrisiran) within 1 year of incident heart failure (HF) diagnosis between 1 September 2019 and 10 December 2025. Patients were categorised as MRA users or non-users and were matched based on 1:1 propensity-score matching. The primary effectiveness endpoint was a composite of all-cause mortality or HF hospitalisation (HFH). Secondary effectiveness endpoints were all-cause mortality, HFH and ventricular arrhythmia (VA). The safety endpoint was hyperkalaemia.
Among 4598 patients with ATTR-CM (mean (SD) age, 77.6 (8.4) years; 3726 (81.0%) men) treated with tafamidis (n=4386) or vutrisiran (n=377), 505 MRA users were matched to 505 non-users. MRA use was not associated with significant reductions in all-cause mortality or HFH (HR 1.04; 95% CI 0.82 to 1.32; p=0.73). There was no significant difference in all-cause mortality (HR 1.00; 95% CI 0.70 to 1.46; p=0.96), HFH (HR 1.09; 95% CI 0.84 to 1.43; p=0.48) and VA (HR 1.07; 95% CI 0.77 to 1.48; p=0.67). Hyperkalaemia was not significantly higher in MRA users (HR 1.13; 95% CI 0.89 to 1.44; p=0.29) compared with non-users.
In a contemporary cohort of patients with ATTR-CM treated with disease-modifying therapy, MRA use was associated with limited incremental clinical benefits.

PMID:
42567692
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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