Research Spotlight: Eplerenone May Reduce Arterial Inflammation Among Individuals with HIV

Suman Srinivasa, MD, MS, a physician investigator in the Endocrine Division/Metabolism Unit at Massachusetts General Hospital and an Assistant Professor of Medicine at Harvard Medical School, is the first author of a new report in JAMA Cardiology, Mineralocorticoid Receptor Antagonism by Eplerenone and Arterial Inflammation in HIV.

This study was conducted in collaboration with Ahmed Tawakol, MD and Shady Abohashem, MD of the Cardiovascular Imaging Research Center/Division of Cardiology at Massachusetts General Hospital.

Summary:

Individuals with HIV well-treated with antiretroviral medications are living longer but have an increased risk of heart disease when compared to the general population. A hormone called aldosterone, which is shown to be elevated in HIV may be associated with inflammatory processes in the heart.

This study was conducted to evaluate whether therapies to block aldosterone levels may reduce the burden and progression of inflammation and heart disease in HIV. The results showed that treatment with eplerenone, an FDA approved medication, for 12 months may reduce arterial inflammation.

What Question Were You Investigating with This Study?

Does mineralocorticoid receptor antagonism reduce arterial inflammation on 18F-fludeoxyglucose–positron emission tomography/computed tomography among persons with HIV —a high-risk group for cardiovascular disease?

What Approach Did You Use?

This was a double-blinded, placebo-controlled randomized controlled trial over 1 year. This was the first use of eplerenone for arterial inflammation in HIV.

What Were the Results?

In this 12-month, placebo-controlled, randomized clinical trial of 26 well-treated persons with HIV without known CVD, eplerenone was associated with a significant reduction in arterial inflammation. An even greater effect was observed in the most diseased segment of the index vessel.

What Are the Clinical Implications?

We have previously shown that persons with HIV (PWH) without clinically evident cardiovascular disease have increased arterial inflammation compared with persons without HIV matched for traditional CVD risk factors. Arterial inflammation among PWH is linked to features of high-risk coronary plaque morphology more prone to rupture and progress rapidly and may account for the 2-fold increased risk of CVD in this population. Eplerenone may be a potential strategy to reduce arterial inflammation in PWH.

What are the Next Steps?

Future prospective studies should evaluate whether mineralocorticoid antagonists improve CVD outcomes in persons with HIV by reducing arterial inflammation.

Paper Cited

Srinivasa, S., Abohashem, S., Walpert, A. R., Dunderdale, C. N., Iyengar, S., Shen, G., Jerosch-Herold, M., deFilippi, C. R., Robbins, G. K., Lee, H., Kwong, R. Y., Adler, G. K., Tawakol, A., & Grinspoon, S. K. (2023). Mineralocorticoid Receptor Antagonism by Eplerenone and Arterial Inflammation in HIV: The MIRABELLA HIV Study. JAMA cardiology, e234578. Advance online publication. https://doi.org/10.1001/jamacardio.2023.4578

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. Mass General is a founding member of the Mass General Brigham healthcare system.