Efficacy and safety of mineralocorticoid receptor antagonists in heart failure: a meta-analysis of randomized controlled trials

MRAs significantly reduce composite cardiovascular outcomes across heart failure phenotypes, with mortality benefits predominantly in HFrEF. Eplerenone appears to offer stronger mortality advantages, while spironolactone is more effective in reducing hospitalizations. These findings support phenotype- and agent-specific strategies to optimize the benefit-risk profile of MRA therapy in heart failure.