Mineralocorticoid receptor antagonists (MRA) play a central role in the therapeutic scheme recommended for patients with heart failure and reduced left ventricular ejection fraction (HFrEF). Three randomized clinical trials support the clinical benefit of MRA in these individuals; spironolactone was associated with increased survival as compared to placebo in patients with HFrEF and severe symptoms [1], while eplerenone showed improved outcomes in patients with HFrEF and mild symptoms [2], and also in patients with reduced left ventricular ejection fraction (LVEF) following an acute myocardial infarction and either symptomatic heart failure (HF) or diabetes mellitus [3].
