Aldosterone, atherosclerosis and vascular events in patients with stable coronary artery disease.
OBJECTIVE
Plasma aldosterone has been associated with all-cause and cardiovascular mortality in high-risk cardiovascular populations, including patients with heart failure, myocardial infarction and high-risk coronary artery disease (CAD) patients. In the present study, we evaluated the association of plasma aldosterone levels with vascular events in a large prospective cohort of stable CAD patients recruited in an outpatient setting. Moreover, we investigated the relationship between aldosterone and atherosclerotic burden.


RESULTS
Baseline plasma aldosterone levels were measured in 2699 subjects with CAD (mean age 60 ± 10 years, 82% male). During a median follow-up of 4.7 years, 308 (11%) patients died, of which 203 were from a vascular cause. Vascular endpoints of myocardial infarction, ischemic stroke or vascular death occurred in 355 (13%) patients. Multivariable Cox regression analysis was performed, adjusting for multiple confounders. Aldosterone (median 96 pg/mL, interquartile range 70-138 pg/mL, normal range 58-362 pg/mL) was independently associated with major vascular events (hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.13-2.15) and vascular mortality (HR 1.95, 95% CI 1.27-3.00). By multivariable regression analysis, aldosterone was also associated with the presence of atherosclerosis in additional vascular territories (cerebrovascular disease and/or peripheral artery disease) (p=0.026).


CONCLUSIONS
In patients with stable coronary artery disease, plasma aldosterone is independently associated with the risk of major vascular events and vascular mortality and with atherosclerotic burden.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Marieke A
MA
Hillaert
Eef G
EG
Lentjes
Hans
H
Kemperman
Yolanda
Y
van der Graaf
Hendrik M
HM
Nathoe
Farzin
F
Beygui
Gilles
G
Montalescot
Pieter A
PA
Doevendans
Annemarie M
AM
Wassink
Eric
E
van Belle
D000368:Aged; D000450:Aldosterone / Q000097:blood*; D050197:Atherosclerosis / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014652:Vascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology
D015415:Biomarkers; D000450:Aldosterone