The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the heart 'OMics' in AGEing (HOMAGE) randomized clinical trial

J.G.F. Cleland*, J.P. Ferreira, B. Mariottoni, P. Pellicori, J. Cuthbert, J.A.J. Verdonschot, J. Petutschnigg, F.Z. Ahmed, F. Cosmi, H.P. Brunner-La Rocca, M.A. Mamas, A.L. Clark, F. Edelmann, B. Pieske, J. Khan, K. McDonald, P. Rouet, J.A. Staessen, B. Mujaj, A. GonzalezJ. Diez, M. Hazebroek, S. Heymans, R. Latini, S. Grojean, A. Pizard, N. Girerd, P. Rossignol, T.J. Collier, F. Zannad, HOMAGE Trial Committees and Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

44 Citations (Web of Science)

Abstract

Aims To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure.Methods and results Randomized, open-Label, blinded-endpoint trial comparing spironolactone (50mg/day) or control for up to 9 months in people with, or at high risk of, coronary disease and raised plasma &type natriuretic peptides. The primary endpoint was the interaction between baseline serum galectin-3 and changes in serum procollagen type-III N-terminal pro-peptide (PIIINP) in participants assigned to spironolactone or control. Procollagen type-1 C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), reflecting synthesis and degradation of type-I collagen, were also measured. In 527 participants (median age 73 years, 26% women), changes in PIIINP were similar for spironolactone and control [mean difference (mdiff): -0.15; 95% confidence interval (CI) -0.44 to 0.15 mu g/L; P=0.32] but those receiving spironolactone had greater reductions in PICP (mdiff: -8.1; 95% CI -11.9 to -4.3 mu g/L; P< 0.0001) and PICP/CITP ratio (mdiff: -2.9; 95% CI -4.3 to -1.5; <0.0001). No interactions with serum galectin were observed. Systolic blood pressure (mdiff: -10; 95% CI -13 to -7 mmHg; P<0.0001), left atrial volume (mdiff: -1; 95% CI -2 to 0 mL/m(2); P = 0.010), and NT-proBNP (mdiff: -57; 95% CI -81 to -33 ng/L; P< 0.0001) were reduced in those assigned spironolactone.Conclusion Galectin-3 did not identify greater reductions in serum concentrations of collagen biomarkers in response to spironolactone. However, spironolactone may influence type-I collagen metabolism. Whether spironolactone can delay or prevent progression to symptomatic heart failure should be investigated.
Original languageEnglish
Pages (from-to)684-+
Number of pages15
JournalEuropean Heart Journal
Volume42
Issue number6
DOIs
Publication statusPublished - 7 Feb 2021

Keywords

  • Spironolactone
  • Heart failure prevention
  • Fibrosis
  • Collagen markers

Cite this