Aldosterone does not predict cardiovascular events following acute coronary syndrome in patients initially without heart failure

Pitts, R. et al. (2017) Aldosterone does not predict cardiovascular events following acute coronary syndrome in patients initially without heart failure. Journal of the American Heart Association, 6(1), e004119. (doi: 10.1161/JAHA.116.004119) (PMID:28073769) (PMCID:PMC5523625)

Abstract

Background: Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk. Methods and Results: To address this question, we examined data from the dal‐OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF <40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow‐up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78‐1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96‐1.99, P=0.08) in Cox regression models adjusted for covariates. Conclusions: In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Pitts, R., Gunzburger, E., Ballantyne, C. M., Barter, P. J., Kallend, D., Leiter, L. A., Leitersdorf, E., Nicholls, S. J., Shah, P. K., Tardif, J.-C., Olsson, A. G., McMurray, J. J.V., Kittelson, J., and Schwartz, G. G.
• Subjects: ?? acute coronary syndrome ??; ?? aldosterone ??; ?? morbidity/mortality ??
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of the American Heart Association
• Publisher: American Heart Association
• ISSN: 2047-9980
• ISSN (Online): 2047-9980
• Published Online: 10 January 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Journal of the American Heart Association 6(1):e004119
• Publisher Policy: Reproduced under a creative commons license