Finerenone and semaglutide: Role in heart failure with reduced ejection fraction

Abstract

Obesity and type 2 diabetes mellitus commonly coexist with heart failure (HF) and may contribute to the pathogenesis of HF with preserved ejection fraction. With progression in management therapies for HF with preserved ejection fraction, the mechanism behind beneficial actions of finerenone and semaglutide remains enigmatic. For decades, the cardiorenal protective effects of aldosterone blockage in patients with chronic kidney disease have been of significant interest. But due to multiple side effects, these trials were likely to stop.

Keywords: Mineralocorticoid receptor antagonist; Finerenone; Semaglutide; Polypill framework; Antifibrotic; Glucagon-like peptide 1; Heart failure

Core Tip: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, acts by reducing pathologic remodeling effects on the heart and kidney while semaglutide improves glycemic control and improves lipid metabolism thereby regulating cardioprotective functions. The combination of finerenone and semaglutide reduces albuminuria and inhibits proinflammatory gene expression, preventing organ damage by mitigating fibrosis and inflammation and reducing obesity-related cardiac remodeling. It has also shown beneficial effects on heart failure with preserved ejection fraction by reducing preload and afterload, thereby improving left ventricular function.