Plasma aldosterone levels in patients with coronary artery disease without heart failure or myocardial infarction: implications for pathophsiology, prognosis, and therapy

This editorial refers to ‘Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure’[†][1], by F. Ivanes et al. , on page 191 Increased plasma levels of aldosterone and cortisol have been associated with an increased risk of mortality and hospitalization for heart failure (HF) in patients with a reduced left ventricular ejection fraction (REF). Mineralocorticoid receptor antagonists (MRAs), which block the effects of both cortisol and aldosterone on the MR,1 are effective in reducing total mortality as well as hospitalizations for HF in patients with chronic HFREF and in patients with HFREF early post-myocardial infarction (MI). Increased levels of aldosterone in patients with HF and a preserved left ventricular ejection fraction (PEF) as well as in patients early post-MI without clinical evidence of HF have also been associated with an increase in cardiovascular risk. MRAs are therefore currently being investigated in patients with HFPEF and in patients with both ST-elevation and non-ST-elevation MI without clinical evidence of HF. Ivanes et al. have reported on the measurement of plasma aldosterone in 799 consecutive patients with coronary artery disease (CAD) referred for elective coronary angioplasty.2 Patients with an acute MI or an acute coronary syndrome requiring urgent revascularization and those with clinical evidence of HF were not included. Over a mean follow-up of 14.9 months, multivariant Cox model analysis showed that plasma aldosterone levels were independently associated with an increase in cardiovascular events. They also found that plasma aldosterone levels provided complementary … [1]: #fn-2