Abstract 12134: Relationship of Plasma Aldosterone Concentration to Cardiovascular Events Following Acute Coronary Syndrome in Patients Without Advanced Heart Failure
Background: Aldosterone may have adverse effects in myocardium and vessel wall, influencing cardiovascular (CV) risk. Mineralocorticoid antagonists reduce CV risk in patients with acute myocardial infarction (MI) complicated by heart failure (HF) or chronic heart failure with reduced ejection fraction (EF). It is uncertain whether aldosterone levels predict adverse cardiovascular outcomes in patients with acute coronary syndrome (ACS), but without advanced HF.
Methods: The dal-Outcomes trial evaluated CV effects of the cholesteryl ester transfer protein inhibitor, dalcetrapib, after ACS. Patients with NYHA class II (with EF< 40%), III, or IV HF were excluded. In a subgroup of 4,073 patients, aldosterone was measured at randomization, 4-12 weeks after ACS. Primary outcomes, assessed over a median follow-up of 37 months, were coronary heart disease death, non-fatal MI, stroke, unstable angina, or resuscitated cardiac arrest; these occurred in 366 patients (9.0%). Hospitalization for heart failure, a secondary outcome, occurred in 72 patients (1.8%).
Results: Baseline median aldosterone was 267 (IQR of 201, 371) pmol/L. Kaplan-Meier curves showed no difference in risk of a primary outcome across quartiles of aldosterone (Figure). Cox proportional hazards analysis, adjusted for demographic, clinical, laboratory, and drug treatment variables did not show a significant relationship of aldosterone to risk of a primary endpoint (for doubling of aldosterone, HR 0.95, 95% CI 0.81-1.12, p=0.55). However, after adjustment, a doubling of aldosterone was significantly associated with HF hospitalizations (HR 1.55, 95% CI 1.09-2.2, p=0.015).
Conclusion: In patients with recent ACS but without advanced HF, aldosterone does not predict major ischemic CV events, but appears to mark an increased risk of HF hospitalization.
Author Disclosures: R. Pitts: None. E. Gunzburger: None. D. Kallend: Employment; Significant; F. Hoffman-La Roche, The Medicines Company. A. Olsson: Honoraria; Modest; AstraZeneca. Consultant/Advisory Board; Modest; Sanofi, Amgen,Pfizer, MSD, Roche. J.J. McMurray: None. J. Kittelson: None. G.G. Schwartz: None.
- © 2015 by American Heart Association, Inc.