Prognostic role of aldosterone in patients with acute coronary syndrome

Mignano, Antonino; Pitruzzella, Valentina; Arnone, Gaspare; Arnone, M.; Rotolo, Antonino; Assennato, Pasquale; Novo, Giuseppina; Corrado, Egle; Novo, Salvatore

doi:10.2459/jcm.0b013e328364129c

Cited by 9 publications

(12 citation statements)

References 11 publications

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“…First, the current analysis cohort is much larger and reflects a globally diverse population with broad application of evidence‐based treatments. Second, in this analysis aldosterone was measured in the subacute period after ACS, whereas in prior studies aldosterone had been measured at the time of presentation with ACS 13, 14, 24, 25. In the immediate period after ACS, left ventricular function, hemodynamics, manifestations of heart failure, and aldosterone levels themselves are in flux 12, 26.…”

Section: Discussionmentioning

confidence: 99%

“…18 In 3 important ways, the present analysis differs from and adds to prior studies that examined the relationship of aldosterone levels to outcomes after ACS. [12][13][14][24][25][26] First, the current analysis cohort is much larger and reflects a globally diverse population with broad application of evidence-based treatments. Second, in this analysis aldosterone was measured in the subacute period after ACS, whereas in prior studies aldosterone had been measured at the time of presentation with ACS.…”

Section: Discussionmentioning

confidence: 99%

“…Prior small studies have associated elevated aldosterone at the time of acute myocardial infarction with increased short‐ and long‐term risk of adverse cardiovascular outcomes 13, 14, 15, 16. However, these studies have had 2 principal limitations.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Plasma aldosterone concentrations are elevated in patients with acute myocardial infarction. 12,13 Prior small studies have associated elevated aldosterone at the time of acute myocardial infarction with increased short-and longterm risk of adverse cardiovascular outcomes. [13][14][15][16] However, these studies have had 2 principal limitations.…”

mentioning

confidence: 99%

“…12,13 Prior small studies have associated elevated aldosterone at the time of acute myocardial infarction with increased short-and longterm risk of adverse cardiovascular outcomes. [13][14][15][16] However, these studies have had 2 principal limitations. First, aldosterone levels are in flux during the early period after myocardial infarction, 12 affected by changing hemodynamic, neurohumoral, and pharmacologic conditions.…”

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confidence: 99%

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Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Pitts

Gunzburger

Ballantyne

et al. 2017

JAHA

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BackgroundAldosterone 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 ResultsTo 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.ConclusionsIn patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Pitts

Gunzburger

Ballantyne

et al. 2017

JAHA

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Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure

et al. 2018

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IMPORTANCE Treatment with aldosterone antagonists is recommended and has been shown to have beneficial effects in patients with ST-segment elevation myocardial infarction (STEMI) and left ventricular ejection fraction (LVEF) less than 40%. However, the role of aldosterone antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known. OBJECTIVES To perform a systematic review and meta-analysis using standard techniques to determine the role of therapy with aldosterone antagonists in this patient population. DATA SOURCES PubMed, Embase, CINAHL, and Cochrane Central databases were searched and a manual search for relevant references from the selected articles and published reviews was performed from database inception through June 2017. STUDY SELECTION Randomized clinical trials that evaluated treatment with aldosterone antagonists in patients with STEMI without clinical heart failure or LVEF greater than 40% were included. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct and report the meta-analysis, which used a random-effects model. Two investigators independently performed the database search and agreed on the final study selection. A manual search was performed for relevant references from the selected articles and published reviews. MAIN OUTCOMES AND MEASURES The outcomes analyzed were mortality, new congestive heart failure, recurrent myocardial infarction, ventricular arrhythmia, and changes in LVEF, serum potassium level, and creatinine level at follow-up. RESULTS In all, 10 randomized clinical trials with a total of 4147 unique patients were included in the meta-analysis. In patients who presented with STEMI without heart failure, treatment with aldosterone antagonists compared with control was associated with lower risk of mortality (2.4% vs 3.9%; odds ratio [OR], 0.62; 95% CI, 0.42-0.91; P = .01) and similar risks of myocardial infarction (1.6% vs 1.5%; OR, 1.03; 95% CI, 0.57-1.86; P = .91), new congestive heart failure (4.3% vs 5.4%; OR, 0.82; 95% CI, 0.56-1.20; P = .31), and ventricular arrhythmia (4.1% vs 5.1%; OR, 0.76; 95% CI, 0.45-1.31; P = .33). Similarly, treatment with aldosterone antagonists compared with control was associated with a small yet significant increase in LVEF (mean difference, 1.58%; 95% CI, 0.18%-2.97%; P = .03), a small increase in serum potassium level (mean difference, 0.07 mEq/L; 95% CI, 0.01-0.13 mEq/L; P = .02), and no change in serum creatinine level (standardized mean difference, 1.4; 95% CI, −0.43 to 3.24; P = .13). CONCLUSIONS AND RELEVANCE Treatment with aldosterone antagonists is associated with a mortality benefit in patients with STEMI with LVEF greater than 40% or without heart failure.

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Aldosterone and Cardiovascular Diseases

Tomasschitz

Pilz

2014

Primary Aldosteronism

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Prognostic role of aldosterone in patients with acute coronary syndrome

Cited by 9 publications

References 11 publications

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure

Aldosterone and Cardiovascular Diseases

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