Clinical InvestigationPrognostic Value of Aldosterone and Cortisol in Patients Hospitalized for Acutely Decompensated Chronic Heart Failure With and Without Mineralocorticoid Receptor Antagonism
Section snippets
Study Design and Population
For the present analysis we made use of the dataset of the Extended Interdisciplinary Network Heart Failure study, a randomized, 2-armed, multicenter trial investigating a nurse-based disease management program for patients with acutely decompensated chronic heart failure. Details of the study design have been reported previously.11 In brief, inclusion criteria comprised age ≥18 years, informed written consent, ability to understand the purpose of the study and to participate in the telephone
Baseline Characteristics
Out of 842 patients, 360 (43%) were using MRAs at baseline (82% spironolactone, 18% eplerenone). The mean daily dose was slightly higher in patients receiving spironolactone compared with eplerenone (30 ± 15 mg vs 26 ± 6 mg; P = .010). Patients on MRAs were younger, had better renal function and lower hs-CRP, and were more often treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs; Table 1). In these patients, however, NYHA functional class was
Discussion
In MRA-naïve patients, higher levels of both aldosterone and cortisol were predictive of an increased mortality risk after comprehensive multivariable adjustment for potential confounders in the present study, thus confirming previously published data.8 Furthermore, in patients treated with MRAs, only higher levels of aldosterone, but not of cortisol, were predictive for all-cause death, questioning a mere associative role of the stress hormone cortisol in this context and strengthening the
Conclusion
High levels of both aldosterone and cortisol were predictive of an increased all-cause mortality risk in MRA-naïve patients with acutely decompensated chronic heart failure. In patients taking MRAs, in contrast, only aldosterone levels were associated with an adverse prognosis. Although the observational design of the present study does not allow any mechanistic conclusions about the impact of cortisol regarding MR activation, the differential prognostic value of cortisol in patients with and
Disclosures
None.
Acknowledgments
The authors thank all patients participating in the INH study and all nurses of the Clinical Study Unit of the Comprehensive Heart Failure Center, Würzburg.
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2017, Biomedicine and PharmacotherapyCitation Excerpt :These factors manipulate CNS, particularly the hypothalamic-pituitary-adrenal (HPA) axis to secrete cortisol. Low cortisol is associated with low cardiac and urine outputs, whereas high cortisol is associated with high blood pressure, bone loss, Cushing’s syndrome, type 2 diabetes etc. [125,126]. Aldosterone, another adrenal corticosteroid level is increased by ACTH, angiotensin II, and potassium, which in turn activates the mineralocorticoid receptors [126].
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High evening salivary cortisol is an independent predictor of increased mortality risk in patients with systolic heart failure
2016, International Journal of CardiologyCitation Excerpt :This is important since patients were frequently still symptomatic at discharge (38% in NYHA functional classes III/IV; Table 1), despite best possible recompensation during their hospitalization for decompensated heart failure. To our surprise, MSC was not associated with mortality risk, although we have previously found such an association (with serum cortisol collected between 7 and 11 am) [5,13]. This divergence is most likely due to a greater variation of MSC compared to ESC, which may be at least partly explained by a higher frequency of stressful components during morning hours that cannot be easily standardized or controlled for in the individual outpatient.
Funding: Grants from the German Ministry of Education and Research (BMBF), Berlin, Germany [BMBF 01GL0304 to Competence Network Heart Failure Germany; BMBF 01GI0205 and BMBF 01EO1004 to Comprehensive Heart Failure Center Würzburg]. GG was supported by a fellowship grant from the Medical Faculty of the University of Würzburg (Habilitationsstipendium).
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