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Type: Journal article
Title: Aldosterone does not predict cardiovascular events following acute coronary syndrome in patients initially without heart failure
Author: Pitts, R.
Gunzburger, E.
Ballantyne, C.
Barter, P.
Kallend, D.
Leiter, L.
Leitersdorf, E.
Nicholls, S.
Shah, P.
Tardif, J.
Olsson, A.
McMurray, J.
Kittelson, J.
Schwartz, G.
Citation: Journal of the American Heart Association, 2017; 6(1):e004119-1-e004119-7
Publisher: Wiley-Blackwell
Issue Date: 2017
ISSN: 2047-9980
Statement of
Reynaria Pitts, Elise Gunzburger, Christie M. Ballantyne, Philip J. Barter, David Kallend, Lawrence A. Leiter, Eran Leitersdorf, Stephen J. Nicholls, Prediman K. Shah, Jean‐Claude Tardif, Anders G. Olsson, John J. V. McMurray, John Kittelson, Gregory G. Schwartz
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.
Keywords: Acute coronary syndrome
Rights: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
DOI: 10.1161/JAHA.116.004119
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