Finerenone benefits in patients with cardio-kidney-metabolic syndrome with or without history of cancer: the FINE-HEART pooled analysis
Abstract
Background and Aims In cardio-kidney-metabolic (CKM) syndrome, comorbid cancer is common due to shared risk factors and overlapping pathophysiologic mechanisms. Whether treatment of CKM conditions with the non-steroidal mineralocorticoid receptor antagonist finerenone may influence or be influenced by comorbid cancer is unknown. Hence, this study aimed to describe clinical features, outcomes, and treatment responses to finerenone in patients with CKM conditions and history of cancer. Methods This was a post hoc analysis of FINE-HEART, a pooled participant-level analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials. The risks of clinical outcomes according to history of cancer and randomization to finerenone were assessed using Cox proportional hazard models and Fine-Gray subdistribution hazard models. Results Among 18 991 participants, 1389 (7.3%) had cancer history, most commonly gastrointestinal, male reproductive, renal/urinary tract, and haematologic cancers. Among those without prior cancer, 915 participants (5.2%) were reported to newly develop cancer during a median follow-up of 2.9 years. Patients with comorbid cancer more often had advanced CKM stages and a greater burden of CKM conditions. History of cancer was associated with higher risks of all-cause mortality and all-cause hospitalization. Finerenone consistently reduced all-cause death, heart failure, and all-cause hospitalization, a composite kidney outcome, major adverse cardiovascular events, and new-onset atrial fibrillation, irrespective of history of cancer. Adverse events were more frequent in patients with history of cancer, but finerenone’s safety profile was consistent. Conclusions Comorbid cancer was frequent in CKM participants and independently associated with worse outcomes, but it did not attenuate the treatment benefit of finerenone.
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BibTeX
@article{ruppert2026finerenone,
title = {{Finerenone benefits in patients with cardio-kidney-metabolic syndrome with or without history of cancer: the FINE-HEART pooled analysis}},
author = {Mihály Ruppert and Muthiah Vaduganathan and Brian L Claggett and Akshay S Desai and Pardeep S Jhund and Alasdair Henderson and James Lay-Flurrie and Meike Brinker and Lucas Hofmeister and Markus S Anker and Carolyn S P Lam and Michele Senni and Sanjiv J Shah and Adriaan A Voors and Faiez Zannad and Peter Rossing and Luis M Ruilope and Bertram Pitt and Rajiv Agarwal and John J V Mcmurray and Scott D Solomon and Stefan D Anker and Gerasimos Filippatos},
journal = {European Heart Journal},
year = {2026},
month = aug,
doi = {10.1093/eurheartj/ehag522},
url = {https://hal.univ-lorraine.fr/hal-05732767v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Finerenone benefits in patients with cardio-kidney-metabolic syndrome with or without history of cancer: the FINE-HEART pooled analysis
AU - Mihály Ruppert
AU - Muthiah Vaduganathan
AU - Brian L Claggett
AU - Akshay S Desai
AU - Pardeep S Jhund
AU - Alasdair Henderson
AU - James Lay-Flurrie
AU - Meike Brinker
AU - Lucas Hofmeister
AU - Markus S Anker
AU - Carolyn S P Lam
AU - Michele Senni
AU - Sanjiv J Shah
AU - Adriaan A Voors
AU - Faiez Zannad
AU - Peter Rossing
AU - Luis M Ruilope
AU - Bertram Pitt
AU - Rajiv Agarwal
AU - John J V Mcmurray
AU - Scott D Solomon
AU - Stefan D Anker
AU - Gerasimos Filippatos
PY - 2026
DA - 2026/08/18
JO - European Heart Journal
DO - 10.1093/eurheartj/ehag522
UR - https://hal.univ-lorraine.fr/hal-05732767v1
AB - Background and Aims In cardio-kidney-metabolic (CKM) syndrome, comorbid cancer is common due to shared risk factors and overlapping pathophysiologic mechanisms. Whether treatment of CKM conditions with the non-steroidal mineralocorticoid receptor antagonist finerenone may influence or be influenced by comorbid cancer is unknown. Hence, this study aimed to describe clinical features, outcomes, and treatment responses to finerenone in patients with CKM conditions and history of cancer. Methods This was a post hoc analysis of FINE-HEART, a pooled participant-level analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials. The risks of clinical outcomes according to history of cancer and randomization to finerenone were assessed using Cox proportional hazard models and Fine-Gray subdistribution hazard models. Results Among 18 991 participants, 1389 (7.3%) had cancer history, most commonly gastrointestinal, male reproductive, renal/urinary tract, and haematologic cancers. Among those without prior cancer, 915 participants (5.2%) were reported to newly develop cancer during a median follow-up of 2.9 years. Patients with comorbid cancer more often had advanced CKM stages and a greater burden of CKM conditions. History of cancer was associated with higher risks of all-cause mortality and all-cause hospitalization. Finerenone consistently reduced all-cause death, heart failure, and all-cause hospitalization, a composite kidney outcome, major adverse cardiovascular events, and new-onset atrial fibrillation, irrespective of history of cancer. Adverse events were more frequent in patients with history of cancer, but finerenone’s safety profile was consistent. Conclusions Comorbid cancer was frequent in CKM participants and independently associated with worse outcomes, but it did not attenuate the treatment benefit of finerenone.
SN - 0195-668X
SN - 1522-9645
ER -