Comparison of the metabolic effects of eplerenone and spironolactone via plasma galectin-3 level in patients with heart failure

Objectives: This study aims to compare the metabolic effect of eplerenone and spironolactone, mineralocorticoid receptor blockers, in patients with heart failure via galectin-3 plasma level. Patients and methods: Between March 2018 and July 2018, 20 heart failure patients (12 males, 8 females; mean age 65.2±7.6 years; range, 58 to 73 years) diagnosed based on clinical parameters and echocardiographic findings were randomized (1:1) to either spironolactone (25 mg/day) or eplerenone (50 mg/day). All patients were also given standard heart failure treatment. We measured plasma levels of galectin-3 with biochemically. Galectin-3 levels were compared before the study and four months after both spironolactone and eplerenone treatment. Results: The mean ejection fraction of the patients was 25.0±4.6% in the eplerenone group and 25.0±4.7% in the spironolactone group. Demographic and hemodynamic characteristics of the patients were comparable between the groups. In both groups, plasma galectin-3 levels were not significantly different prior to initiation of mineralocorticoid receptor antagonist therapy (p=0.307). In patients receiving eplerenone, the mean plasma galectin-3 levels decreased from 898.6±23.4 to 99.7±7.9 four months after the treatment (p=0.0004). In the spironolactone group, galectin-3 levels prior to and after treatment did not change significantly (p=0.201). Conclusion: Galectin-3 concentration, which is an emerging marker of cardiac fibrosis, statistically decreased in the eplerenone group rather than spironolactone group. Based on this finding, we can speculate that eplerenone is more effective than spironolactone in preventing fibrosis and inflammation in patients with heart failure.