Abstract 15812: Aldosterone Predicts Long-term Secondary Outcome in Patients With Stable Coronary Artery Disease: Results from the SMART prospective cohort study
Aldosterone has recently been shown to be associated with unfavourable clinical outcome in high-risk cardiovascular populations (i.e. heart failure, acute myocardial infarction or percutaneous coronary intervention). This study aimed to assess the predictive value of plasma aldosterone levels in an apparently stable secondary prevention population.
Methods and Results: Baseline aldosterone levels were measured in 2115 subjects (mean age 61±10 years, 81% male) with stable coronary artery disease (CAD), recruited in an outpatient setting (SMART prospective cohort). During a mean follow-up of 4.0 years, the primary endpoint of cardiovascular (CV) mortality occurred in 145 (6.9%) patients. The secondary endpoint of total mortality occurred in 207 (9.8%) patients. This low mortality rate reflects the relatively low risk of this population. Plasma aldosterone levels (median 99 pg/ml, IQ range 71–142 pg/ml) were positively associated with hsCRP (p<0.001), LDLcholesterol (p<0.001) and creatinine (p<0.001) and were higher in females (p=0.015), in patients with hypertension (p<0.001) or using diuretics (p<0.001) and lower in patients using betablockers (p=0.001). Univariate Cox survival analysis showed that higher aldosterone levels were associated with higher CV (Chi2=22.3; HR[1log increase]=2.02[1.51–2.70]; p<0.001) and total (Chi2=20.5; HR[1log increase]=1.77[1.39–2.27]; p<0.001) mortality. Higher aldosterone values (above vs below median) were associated with a higher actuarial CV (7.5% vs 3.2%) and total (9.5% vs 5%) mortality at 4 years. In multivariable Cox survival analysis, aldosterone was a strong and independent predictor of CV and total mortality (Table).
Conclusion: Plasma aldosterone is an independent predictor of long-term CV and total mortality in patients with stable CAD. Plasma aldosterone levels might prove helpful in detecting higher-risk patients within apparently stable secondary prevention populations.
- © 2010 by American Heart Association, Inc.