Heart failure & cardiomyopathiesSecondary analysis
Interaction Between Aldosterone and Mineralocorticoid Receptor Antagonist
- Secondary analysis of the EPHESUS randomised trial
Authors' conclusion
In patients with left ventricular systolic dysfunction and/or HF after myocardial infarction, higher baseline or rising aldosterone levels were associated with increased risk of HF events. However, eplerenone mitigated aldosterone-associated risks.
Study context
- Population
- Patients with LV systolic dysfunction and/or heart failure (HF) after MI (EPHESUS subset)
- Participants
- 453 patients
- Comparison
- Association of serum aldosterone with outcomes, eplerenone vs placebo
- Primary endpoint
- CV death or HF hospitalization
Primary result
As reported in the abstract
CV death or HF hospitalization per 1 ng/dL higher baseline serum aldosterone
HR per 1 ng/dL (95% CI)P value
Placebo
1.04(1.02–1.07)
P = 0.002Eplerenone
0.99(0.93–1.05)
P = 0.64Per 1 ng/dL higher baseline serum aldosterone, as printed
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| CV death or HF hospitalization with high serum aldosterone change (≥ median) — Placebo vs Placebo · persisted after covariate adjustment | 3.48 (1.35–8.99) | P = 0.01 | |
| CV death or HF hospitalization with high serum aldosterone change (≥ median) — Eplerenone vs Placebo · persisted after covariate adjustment | 0.81 (0.36–1.82) | P = 0.60 | |
| 0.10.31310Hazard ratio (log scale) |
- CV death or HF hospitalization with high serum aldosterone change (≥ median): P for interaction = 0.046
Baseline serum aldosterone (all patients)
- Median serum aldosterone
- 5.6 ng/dL (Q1-Q3: 3.1-9.2 ng/dL)
Change in serum aldosterone · month 1
- Eplerenone increased serum aldosterone more than placebo
- P < 0.001
Original publication
Interaction Between Aldosterone and Mineralocorticoid Receptor Antagonist. JACC Heart Fail. Published 1 July 2025. doi:10.1016/j.jchf.2025.02.025
Summarised from the published abstract; every number is checked against it