Mineralocorticoid receptor antagonists reduce new-onset atrial fibrillation across the cardio-kidney-metabolic spectrum: a meta-analysis of randomized clinical trials

Atrial fibrillation is a prevalent arrhythmia and comorbidity among patients with cardio-kidney-metabolic (CKM) conditions, such as obesity, Type 2 diabetes (T2D), chronic kidney disease (CKD), and heart failure (HF). Patients with atrial fibrillation, compared with those without, have an increased risk of adverse cardiovascular and kidney events, spanning from stroke and HF to progression of kidney disease and cardiovascular mortality.1 Therefore, treatment strategies that reduce or delay the development of atrial fibrillation are crucial to improve outcomes, decrease the burden of the disease, and reduce healthcare-associated costs across different CKM conditions. Mineralocorticoid receptor antagonists (MRAs) may reduce the incidence and burden of atrial fibrillation, potentially by preventing atrial remodelling and fibrosis in the atria.2 Still, their effects on atrial fibrillation have not been consistent across populations and a meta-analysis of randomized controlled trials (RCTs) may increase the power to ascertain treatment effects and assess potential heterogeneity between different trials and populations.