CARDIOVASCULAR OUTCOMES WITH FINERENONE ACCORDING TO STATUS OF GLYCEMIA AT BASELINE AND PRIOR TREATMENT WITH NEWER ANTIDIABETICS AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Type 2 diabetes mellitus (T2DM) and cardiovascular disease are closely interconnected. We sought to determine the cardio-protective action of finerenone according to prior treatment with newer antidiabetics and level of glycemic status. Design and method: We searched PubMed and Cochrane Library from inception to 1st October 2021 for randomized controlled trials (RCTs) assessing the effect of finerenone on major adverse cardiovascular outcomes in patients with T2DM. We set as primary endpoint the composite of major adverse cardiovascular event, defined as the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure (MACE). Results: We finally included 2 RCTs in our quantitative synthesis. Finerenone compared to placebo induced a 23% risk reduction for the composite cardiovascular endpoint, regardless of prior glycemia. We also showed that finerenone provided significant cardiovascular benefit for obese patients with T2DM, compared to placebo, which was diminished for subjects with a body mass index (BMI) lower than 30 kg/m2. Finally, combination of finerenone with SGLT-2 inhibitors or GLP-1RAs did not produce a significant risk reduction for MACE. Conclusions: Finerenone provides significant cardiovascular benefit for patients with T2DM, especially for those being obese, while the level of glycemia or treatment with newer antidiabetics at baseline does not seem to affect the observed cardio-protective action.