Bioprofiling Response to Mineralocorticoid Receptor Antagonists for the Prevention of Heart Failure

Inclusion Criteria: * Written informed consent will be obtained prior to any study procedure; * Age \>60 years * Clinical risk factors for developing heart failure, either: 1. Coronary artery disease (h/o myocardial infarction, angioplasty or coronary artery bypass) Or 2. At least two of the following: * Diabetes Mellitus requiring Hypoglycaemic Pharmacotherapy * Receiving pharmacological treatment for Hypertension * Microalbuminuria * Abnormal ECG (left ventricular hypertrophy, QRS \>120msec, abnormal Q-waves) * Biological risk: NT-pro-BNP values between 125 and 1,000 ng/L or BNP values between 35 and 280 pg/ml (consistent with ESC guidelines indicating risk of HF but helping to rule out prevalent HF or atrial fibrillation which are associated with marked increases in NT-proBNP/BNP and should be investigated) Exclusion Criteria: * Recent wound healing/inflammation: * Surgical procedure, coronary, cerebral or peripheral vascular events or infection in the prior 3 months * Cancer * Autoimmune disease * Hepatic Disease * Pre-existing diagnosis of clinical HF * Moderate/severe LV systolic ventricular dysfunction, i.e. LVEF \<45% * Moderate or severe valve disease (investigators opinion) * eGFR\< 30ml/min * Serum potassium \>5.0 mmol/L * Treatment with an MRA or a loop diuretic (furosemide, bumetanide, ethacrynic acid or torasemide) in the previous three months * Potassium supplements or potassium-sparing diuretic at time of enrolment. * Atrial fibrillation within one month prior to inclusion (AF lasting \<60 seconds on ambulatory ECG monitoring is permitted) •. History of hypersensitivity to spironolactone. * Requiring treatment with prohibited medication according to SmPC with exception of ACE inhibitors or angiotensin receptor blockers * Patients unable to give written informed consent. * Participation in another interventional trial in the preceding month * Ability to walk is, in the investigators opinion, clearly limited by joint disease or other locomotor problems rather than by cardiorespiratory fitness