Journal of the American College of Cardiology · 2025
Anthropometric Measures, Cardiovascular Outcomes, and Treatment Effects of Finerenone in Cardiovascular-Kidney-Metabolic Disease: Pooled Participant-Level Analysis of 3 Global Trials.
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Ostrominski John W, Harrington Josephine, Claggett Brian L, Filippatos Gerasimos, Desai Akshay S, Jhund Pardeep S, Henderson Alasdair D, Lam Carolyn S P, Senni Michele, Shah Sanjiv J, Voors Adriaan A, Zannad Faiez, Rossing Peter, Ruilope Luis M, Anker Stefan D, Pitt Bertram, Agarwal Rajiv, Brinker Meike D, Rohwedder Katja, Lay-Flurrie James, Lage Andrea, McMurray John J V, Solomon Scott D, Vaduganathan Muthiah
Аннотация
BACKGROUND: Obesity is a core pathophysiologic contributor to cardiovascular, kidney, and metabolic (CKM) conditions. However, the association between different adiposity-related anthropometrics and cardiovascular outcomes in persons with CKM conditions has not been rigorously explored.
OBJECTIVES: In this study, the authors sought to examine cardiovascular outcomes and treatment effects of finerenone according to different adiposity-related anthropometrics.
METHODS: In this prespecified participant-level pooled analysis of FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF (FINE-HEART), cardiovascular outcomes and treatment effects of finerenone according to baseline body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), and waist-hip ratio (WHR) were evaluated with the use of multivariable-adjusted Cox proportional hazards regression and Poisson regression.
RESULTS: Of 18,759 participants with available data for all anthropometrics, 52% had a BMI ≥30 kg/m2 and 98% had any excess adiposity. Among those with BMI <30 kg/m2, 95% had increased abdominal adiposity, especially women and older individuals. Higher BMI, WC, WHtR, and WHR were each significantly associated with a wide range of cardiovascular outcomes, including cardiovascular death or heart failure (HF) hospitalization and its individual components, major adverse cardiovascular events, new-onset atrial fibrillation, and incident HF hospitalization. BMI-adjusted WHtR and WHtR-adjusted BMI were each associated with a higher rate of cardiovascular death or HF hospitalization, and participants with elevated BMI and WHtR experienced a higher rate of cardiovascular death or HF hospitalization compared with those with elevated BMI or WHtR alone (P < 0.001). Benefits of finerenone on cardiovascular death or HF hospitalization were consistent regardless of baseline BMI (Pinteraction = 0.27) or WHtR (Pinteraction = 0.26), and absolute benefits appeared to be greater among participants with higher adiposity. Serious adverse events were less common with finerenone vs placebo, regardless of baseline BMI category (Pinteraction = 0.08).
CONCLUSIONS: These findings suggest that assessment of anthropometrics capturing abdominal adiposity, in addition to BMI, may enhance obesity identification and risk stratification among individuals with CKM conditions. Finerenone consistently reduced adverse cardiovascular outcomes across a wide range of adiposity. (FINE-HEART: An Integrated Pooled Analysis of Finerenone Across 3 Phase III Trials of Heart Failure and Chronic Kidney Disease and Type 2 Diabetes; CRD42024570467).
OBJECTIVES: In this study, the authors sought to examine cardiovascular outcomes and treatment effects of finerenone according to different adiposity-related anthropometrics.
METHODS: In this prespecified participant-level pooled analysis of FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF (FINE-HEART), cardiovascular outcomes and treatment effects of finerenone according to baseline body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), and waist-hip ratio (WHR) were evaluated with the use of multivariable-adjusted Cox proportional hazards regression and Poisson regression.
RESULTS: Of 18,759 participants with available data for all anthropometrics, 52% had a BMI ≥30 kg/m2 and 98% had any excess adiposity. Among those with BMI <30 kg/m2, 95% had increased abdominal adiposity, especially women and older individuals. Higher BMI, WC, WHtR, and WHR were each significantly associated with a wide range of cardiovascular outcomes, including cardiovascular death or heart failure (HF) hospitalization and its individual components, major adverse cardiovascular events, new-onset atrial fibrillation, and incident HF hospitalization. BMI-adjusted WHtR and WHtR-adjusted BMI were each associated with a higher rate of cardiovascular death or HF hospitalization, and participants with elevated BMI and WHtR experienced a higher rate of cardiovascular death or HF hospitalization compared with those with elevated BMI or WHtR alone (P < 0.001). Benefits of finerenone on cardiovascular death or HF hospitalization were consistent regardless of baseline BMI (Pinteraction = 0.27) or WHtR (Pinteraction = 0.26), and absolute benefits appeared to be greater among participants with higher adiposity. Serious adverse events were less common with finerenone vs placebo, regardless of baseline BMI category (Pinteraction = 0.08).
CONCLUSIONS: These findings suggest that assessment of anthropometrics capturing abdominal adiposity, in addition to BMI, may enhance obesity identification and risk stratification among individuals with CKM conditions. Finerenone consistently reduced adverse cardiovascular outcomes across a wide range of adiposity. (FINE-HEART: An Integrated Pooled Analysis of Finerenone Across 3 Phase III Trials of Heart Failure and Chronic Kidney Disease and Type 2 Diabetes; CRD42024570467).