Cardiovascular Risk Beyond Heart Issues
New research shows not all cardiovascular disease risks start in the heart — metabolic health, kidney function, and inflammatory conditions all play significant roles. The findings suggest a holistic approach beyond just cholesterol and blood pressure is necessary for prevention. Meanwhile, the FINEARTS-HF trial found that finerenone significantly reduces cardiovascular death and heart failure events in patients with chronic kidney disease.
Metabolic syndrome, a cluster of conditions including excess abdominal fat, high blood pressure, and elevated blood sugar, can double the risk of dying from coronary heart disease and triple the risk of a heart attack or stroke. For some, this combination of factors may eventually become a greater risk for cardiovascular disease than cigarette smoking. The link between the heart and kidneys is a two-way street; heart disease is the leading cause of death for people with kidney disease. When kidneys are unable to properly filter waste and regulate fluids, it can cause high blood pressure and strain the heart. Conversely, when the heart doesn't pump blood effectively, the kidneys can be damaged from a lack of adequate blood flow. Chronic inflammation plays a direct role in all stages of atherosclerosis, the process of plaque buildup that hardens and narrows arteries. This inflammation can be measured with a blood test for high-sensitivity C-reactive protein (hs-CRP), a protein produced by the liver. Elevated levels of hs-CRP are linked to a two to three times higher risk of a future heart attack compared to those with low levels. Finerenone, the drug studied in the FINEARTS-HF trial, is a non-steroidal mineralocorticoid receptor antagonist (MRA). It works by selectively blocking the overactivation of receptors in the heart and kidneys that can lead to inflammation and fibrosis, or scarring. The FINEARTS-HF trial focused on patients with a common type of heart failure where the heart's pumping function is only mildly reduced or preserved. In these patients, finerenone was shown to lower the combined rate of worsening heart failure events and cardiovascular death. Prior to FINEARTS-HF, the FIDELIO-DKD and FIGARO-DKD trials had already shown finerenone's benefits. In patients with chronic kidney disease and type 2 diabetes, the drug reduced the risk of cardiovascular events, including hospitalization for heart failure, by 14% compared to a placebo.
