Emerging cardiovascular indications of mineralocorticoid receptor antagonists

• Mineralocorticoid receptor (MR) antagonists have proven benefits in hypertension and heart failure.
• Atrial fibrillation (AF), pulmonary hypertension, renal failure, and stroke are emerging indications for MR antagonists.
• Further data are needed for emerging indication and non-steroidal MR antagonists.

Mineralocorticoid receptor (MR) antagonism is a well-established treatment modality for patients with hypertension, heart failure, and left ventricular systolic dysfunction (LVSD) post-myocardial infarction (MI). There are emerging data showing potential benefits of MR antagonists in other cardiovascular conditions. Studies have shown association between MR activation and the development of myocardial fibrosis, coronary artery disease, metabolic syndrome, and cerebrovascular diseases. This review examines the preclinical and clinical data of MR antagonists for novel indications including heart failure with preserved ejection fraction (HFPEF), pulmonary arterial hypertension (PAH), arrhythmia, sudden cardiac death, valvular heart disease, metabolic syndrome, renal disease, and stroke. MR antagonists are not licensed for these conditions yet; however, emerging data suggest that indication for MR antagonists are likely to broaden; further studies are warranted.