Discussion
overt systolic dysfunction, heart failure, cardiovascular disease
HEART FAILURE, TYPE 2 DIABETES, CARDIOVASCULAR DISEASE
In the present echocardiography sub-study of the MIRAD trial, no improvement was observed in either systolic, diastolic left ventricular function or LVMi following treatment with high-dose eplerenone for a duration of 26 weeks in a cohort of high-risk type 2 diabetes patients without known heart failure.The increased risk of cardiovascular disease following the diagnosis of type 2 diabetes is well-established, with the concomitant diagnose of heart failure further substantially impairing prognosis [We did not observe an effect of high-dose MRA therapy on systolic ventricular function in this cohort without HFrEF. The lack of a change in a cohort of patients in stable antidiabetic and antihypertensive treatment without overt systolic dysfunction at baseline is in line with previous publications, where trials have yet to observe a consistent improvement in LVEF in patients without HFrEF following MRA therapy [Although MRAs have long been used as antihypertensives, experimental studies in animal models investigating the underlying mechanisms of MRA therapy have demonstrated extra-renal, receptor-mediated effects shown to be independent of the expected diuretic and antihypertensive effects mediated by mineralocorticoid receptor activation in the distal tubules of the kidneys [The clinical benefit of finerenone as shown by the pooled-analysis, FIDELITY, as well as the recent advances in outlining the mechanism of extra-renal MRA therapy [