title: Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure.
abstract: 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.
  
  
  
  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.
  
  
  
  In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.
authors.affiliation: Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, CO.
authors.forename: Reynaria
authors.initials: R
authors.lastname: Pitts
authors.affiliation: University of Colorado School of Public Health, Aurora, CO.
authors.forename: Elise
authors.initials: E
authors.lastname: Gunzburger
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Barter
authors.affiliation: The Medicines Company, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Kallend
authors.affiliation: Division of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Leitersdorf
authors.affiliation: South Australian Health and Medical Research Institute, University of Adelaide, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA.
authors.forename: Prediman K
authors.initials: PK
authors.lastname: Shah
authors.affiliation: Montreal Heart Institute, Université de Montréal, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Anders G
authors.initials: AG
authors.lastname: Olsson
authors.affiliation: University of Glasgow, Scotland.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: University of Colorado School of Public Health, Aurora, CO.
authors.forename: John
authors.initials: J
authors.lastname: Kittelson
authors.affiliation: Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, CO gregory.schwartz@va.gov.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Schwartz
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D000577:Amides; D000789:Angina, Unstable / Q000453:epidemiology; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases; D003327:Coronary Disease / Q000401:mortality*; D004952:Esters; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology*; D013438:Sulfhydryl Compounds / Q000627:therapeutic use
chemical_list: D000577:Amides; D000924:Anticholesteremic Agents; D004952:Esters; D013438:Sulfhydryl Compounds; C411602:dalcetrapib; D000450:Aldosterone
keywords: acute coronary syndrome; aldosterone; morbidity/mortality