title: Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure.
abstract: BACKGROUND
  Recent studies have demonstrated that aldosterone levels measured in patients with heart failure or acute myocardial infarction (MI) are associated with long-term mortality, but the association with aldosterone levels in patients with coronary artery disease (CAD) outside these specific settings remains unknown. In addition, no clear mechanism has been elucidated to explain these observations. The present study was designed to evaluate the relationship between the level of aldosterone and the risk of death and acute ischaemic events in CAD patients with a preserved left ventricular (LV) function and no acute MI.
  
  
  RESULTS
  In 799 consecutive CAD patients referred for elective coronary angioplasty measurements were obtained before the procedure for: aldosterone (median = 25 pg/mL), brain natriuretic peptide (BNP) (median = 35 pg/mL), hsC-reactive protein (median = 4.17 mg/L), and left ventricular ejection fraction (mean = 58%). Patients with acute MI or coronary syndrome (ACS) who required urgent revascularization were not included in the study. The primary endpoint, cardiovascular death, occurred in 41 patients during a median follow-up period of 14.9 months. Secondary endpoints-total mortality, acute ischaemic events (acute MI or ischaemic stroke), and the composite of death and acute ischaemic events-were observed in 52, 54, and 94 patients, respectively. Plasma aldosterone was found to be related to BMI, hypertension and NYHA class, and inversely related to age, creatinine clearance, and use of beta-blockers. Multivariate Cox model analysis demonstrated that aldosterone was independently associated with cardiovascular mortality (P = 0.001), total mortality (P = 0.001), acute ischaemic events (P = 0.01), and the composite of death and acute ischaemic events (P = 0.004). Reclassification analysis, using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), demonstrated incremental predictive value of aldosterone (P < 0.0001).
  
  
  CONCLUSIONS
  Our results demonstrate that, in patients with CAD but without heart failure or acute MI, the level of aldosterone is strongly and independently associated with mortality and the occurrence of acute ischaemic events.
authors: Department of Cardiology, University Hospital, Lille, France.
authors: Fabrice
authors: F
authors: Ivanes
authors: Sophie
authors: S
authors: Susen
authors: Frédéric
authors: F
authors: Mouquet
authors: Pascal
authors: P
authors: Pigny
authors: François
authors: F
authors: Cuilleret
authors: Karine
authors: K
authors: Sautière
authors: Jean-Philippe
authors: JP
authors: Collet
authors: Farzin
authors: F
authors: Beygui
authors: Bernadette
authors: B
authors: Hennache
authors: Pierre Vladimir
authors: PV
authors: Ennezat
authors: Françis
authors: F
authors: Juthier
authors: Florence
authors: F
authors: Richard
authors: Jean
authors: J
authors: Dallongeville
authors: Marieke A
authors: MA
authors: Hillaert
authors: Pieter A
authors: PA
authors: Doevendans
authors: Brigitte
authors: B
authors: Jude
authors: Michel
authors: M
authors: Bertrand
authors: Gilles
authors: G
authors: Montalescot
authors: Eric
authors: E
authors: Van Belle
mesh_terms: D000367:Age Factors; D000368:Aged; D000450:Aldosterone / Q000378:metabolism*; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D015992:Body Mass Index; D002545:Brain Ischemia / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D003404:Creatinine / Q000378:metabolism; D016757:Death, Sudden, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D002097:C-Reactive Protein; D003404:Creatinine