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Published on: June 10, 2025
Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without
Reynaria Pitts1, Elise Gunzburger2, Christie M Ballantyne3
1Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, CO.
Insights
Aldosterone does not predict major cardiovascular events in patients recovering from acute coronary syndrome without advanced heart failure. This finding is crucial for understanding cardiovascular risk in a broad patient population.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Trials
Background:
- Aldosterone is implicated in cardiovascular damage, and its antagonists benefit patients with heart failure (HF) post-myocardial infarction.
- However, the role of aldosterone in predicting cardiovascular risk among acute coronary syndrome (ACS) patients without advanced HF remains unclear.
Purpose of the Study:
- To investigate whether aldosterone levels predict major adverse cardiovascular events (MACE) in patients who have experienced an ACS but do not have advanced heart failure.
Main Methods:
- Analysis of data from the dal-OUTCOMES trial, including 4073 patients randomized 4-12 weeks after ACS.
- Exclusion of patients with New York Heart Association class II (LVEF <40%), III, or IV HF.
- Aldosterone levels were measured at randomization; primary outcome was a composite of cardiovascular death, MI, stroke, unstable angina, or cardiac arrest. HF hospitalization was a secondary endpoint.
Main Results:
- Over a median follow-up of 37 months, no significant association was found between aldosterone levels and the primary composite outcome (HR 0.92 per doubling, P=0.34).
- Aldosterone also did not predict hospitalization for HF (HR 1.38 per doubling, P=0.08).
Conclusions:
- In patients with recent ACS but without advanced HF, aldosterone levels do not serve as a predictor of major cardiovascular events.
- These findings suggest that aldosterone's prognostic value in cardiovascular disease may be context-dependent, particularly concerning the presence and severity of heart failure.
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.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.
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