Breakthrough Mineralocorticoid Receptor Agonists in Cardiovascular Care
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3m 41sPart 1 | Session 1 Introduction and Landscape Overview by Dr Vijay Chopra
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11m 13s
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11m 14s
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16m 19s
In this lively expert panel discussion, Dr Javed Butler, Prof John McMurray, Dr Dinesh Khullar, and Dr Vijay Chopra explore the practical challenges of hyperkalaemia management, optimisation of RAAS inhibition, and the emerging role of aldosterone synthesis inhibitors (ASIs) in heart failure and chronic kidney disease.
The discussion covers:
• When to start potassium-lowering therapy, and how thresholds must be individualised based on patient factors, clinician judgement, and access to binders
• The comparative features of patiromer and sodium zirconium cyclosilicate, including onset of action, sodium load, and use in chronic versus acute hyperkalaemia
• New insights from the PODCAST trial, suggesting potential benefits of maintaining potassium at the upper end of normal in patients vulnerable to arrhythmias
• Differences between acute and chronic hyperkalaemia, and why CKD patients often tolerate higher potassium levels
• Practical alternatives to binders, including SGLT2 inhibitors, diuretics, and neprilysin inhibition, all of which can help lower potassium
• A deeper exploration of genomic and non-genomic aldosterone pathways, and whether ASIs may offer theoretical advantages over MRAs
The panel also highlights the rapidly evolving field of ASI research, with major trials underway in:
• Heart failure with reduced ejection fraction (HFrEF)
• Heart failure with preserved or mildly reduced EF (HFpEF/HFmrEF)
• Heart failure prevention in high-risk patients with type 2 diabetes and hypertension
• Chronic kidney disease, where managing potassium and blood pressure will be central to successful implementation
The session closes with reflections on how ASIs and MRAs may eventually complement one another, the need for safer aldosterone-modulating strategies in CKD, and why the next five years may reshape the way clinicians target aldosterone across cardiorenal medicine.
In this expert-led webinar moderated by Dr Vijay Chopra, leading clinicians review current and emerging strategies in aldosterone modulation, hyperkalaemia management, and cardiorenal therapeutics.
Dr Javed Butler opens with a practical overview of aldosterone’s central role in heart failure and CKD, emphasising the importance of achieving guideline-directed RAAS inhibitor and MRA dosing. He outlines real-world barriers posed by hyperkalaemia and provides clear strategies to maintain life-saving therapy safely, including the use of modern potassium binders.
Dr Dinesh Khullar presents the clinical evidence for finerenone, a non-steroidal MRA with improved selectivity and a lower risk of hyperkalaemia. He summarises key findings from FIDELITY, CONFIDENCE, and FINEARTS-HF, demonstrating meaningful reductions in CKD progression, heart failure events, albuminuria, and cardiovascular risk, particularly when combined with SGLT2 inhibitors.
Prof John McMurray explores the future of aldosterone-targeted therapy with aldosterone synthase inhibitors (ASIs). He reviews promising hypertension data for agents such as baxdrostat and outlines large-scale ongoing trials investigating ASIs in HFrEF, HFpEF, CKD, and heart failure prevention, pointing toward a major shift in proactive cardiorenal care.
The session concludes with a dynamic panel discussion addressing potassium thresholds, binder selection, chronic vs acute hyperkalaemia tolerance, insights from the PODCAST trial, and the scientific rationale behind combining MRAs and ASIs.
Overall, this webinar offers a concise, clinically relevant look at today’s best practices and tomorrow’s innovations in cardiorenal medicine.
For more on emerging strategies in aldosterone inhibition, read Cardiac Failure Review Journal’s Special Focus Issue on “New Mineralocorticoid Receptor Antagonists/Aldosterone Antagonists”.
Key Learning Objectives
- Identify clinical barriers associated with traditional aldosterone management and recognize the impact of hyperkalemia on patient outcomes and treatment adherence
- Evaluate the clinical evidence supporting non-steroidal MRAs, particularly finerenone, and understand their role in modern cardiovascular therapeutic strategies
- Apply practical strategies for implementing breakthrough MRA therapies while managing potassium levels and optimizing patient safety profiles
- Distinguish between different approaches to mineralocorticoid pathway modulation, including receptor antagonism and aldosterone synthesis inhibition
- Integrate evidence-based protocols for MRA therapy selection and monitoring in patients with hypertension and heart failure
- Assess patient-specific factors that influence MRA therapy choice and develop personalized treatment approaches for diverse cardiovascular populations
Target Audience
- Cardiologists and interventional cardiologists managing heart failure and hypertensive patients
- Clinical pharmacologists specializing in cardiovascular therapeutics
- Heart failure specialists and advanced heart failure practitioners
- Cardiovascular medicine fellows and cardiology residents
- Nephrology specialists managing patients with cardiovascular comorbidities
More from this programme
Part 1
Breakthrough Mineralocorticoid Receptor Agonists in Cardiovascular Care
In this expert-led webinar moderated by Dr Vijay Chopra, leading clinicians review current and emerging strategies in aldosterone modulation, hyperkalaemia management, and cardiorenal therapeutics.
Dr Javed Butler opens with a practical overview of aldosterone’s central role in heart failure and CKD, emphasising the importance of achieving guideline-directed RAAS inhibitor and MRA dosing. He outlines real-world barriers posed by hyperkalaemia and provides clear strategies to maintain life-saving therapy safely, including the use of modern potassium binders.
Dr Dinesh Khullar presents the clinical evidence for finerenone, a non-steroidal MRA with improved selectivity and a lower risk of hyperkalaemia. He summarises key findings from FIDELITY, CONFIDENCE, and FINEARTS-HF, demonstrating meaningful reductions in CKD progression, heart failure events, albuminuria, and cardiovascular risk, particularly when combined with SGLT2 inhibitors.
Prof John McMurray explores the future of aldosterone-targeted therapy with aldosterone synthase inhibitors (ASIs). He reviews promising hypertension data for agents such as baxdrostat and outlines large-scale ongoing trials investigating ASIs in HFrEF, HFpEF, CKD, and heart failure prevention, pointing toward a major shift in proactive cardiorenal care.
The session concludes with a dynamic panel discussion addressing potassium thresholds, binder selection, chronic vs acute hyperkalaemia tolerance, insights from the PODCAST trial, and the scientific rationale behind combining MRAs and ASIs.
Overall, this webinar offers a concise, clinically relevant look at today’s best practices and tomorrow’s innovations in cardiorenal medicine.
Faculty Biographies
Vijay Chopra
Senior Director of Clinical Cardiology, Heart Failure and Research
Dr Vijay Chopra is the Senior Director of Clinical Cardiology, Heart Failure and Research in the Heart Failure Programme at the Max Super Specialty Hospital in Saket, New Delhi, India. He is considered a pioneer in preventive cardiology, and has worked extensively in the management of patients with advanced heart disease. He has been principal investigator of numerous international clinical trials.
Dr Chopra's research interests include preventive cardiology, heart failures and advanced heart diseases. He was awarded the Kutumbiah Prize in Clinical Medicine from CMC Vellore in 1972. He founded the Heart Failure Association of India (HFAI), and served as its first president from 2014 - 2019.
Dr Chopra has over 50 publications in peer-reviewed journals.
Dr Vijay Chopra is an Editorial Board member of Cardiac Failure Review and may be contacted
Javed Butler
Professor of Medicine
Dr Javed Butler is President, Baylor Scott and White Research Institute, Senior Vice President for the Baylor Scott and White Health and Professor of Medicine at the University of Mississippi, US. He is board certified in cardiovascular medicine and advanced heart failure and transplant medicine. His research interests focus on clinical trials in patients with heart failure.
He serves on several national committees for the American College of Cardiology, American Heart Association, National Institutes of Health, and the Heart Failure Society of America. He is the recipient of the Simon Dack Award by the American College of Cardiology as well as the Time, Feeling, and Focus Award by the American Heart Association.
Prof Butler has authored more than 900 peer-reviewed publications. He serves on the editorial board of several peer reviewed cardiovascular journals and has been cited numerous times in America’s Best Doctors list.
John JV McMurray
Professor of Cardiology
Prof John McMurray is Professor of Medical Cardiology and Deputy Director of the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, and honorary Consultant Cardiologist at the Queen Elizabeth University Hospital, Glasgow. A graduate of Manchester University, Prof McMurray completed postgraduate research at the University of Dundee.
Prof McMurray is a Fellow of the European Society of Cardiology (ESC), American College of Cardiology and American Heart Association as well as the medical Royal Colleges in Edinburgh and Glasgow and the Royal Society of Edinburgh and UK Academy of Medical Sciences.
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