Is the Female Heart More Sensitive to Aldosterone for Early Remodeling?

March 8, 2008

Hypertension. 2004;43:936-937

A. Duprez

From the Cardiovascular Division, University of Minnesota, Minneapolis.

Excerpts:

The Randomized Aldactone Evaluation Study (RALES) and Eplerenone Post-Acute

Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS)

clearly demonstrated that antagonizing aldosterone on top of inhibition of

the ACE or on top of blocking of the angiotensin II receptor had a major

beneficial effect in risk reduction of cardiovascular morbidity and

mortality in severe heart failure and postmyocardial infarction

Left ventricular hypertrophy confers an excess risk of cardiovascular and

cerebrovascular events in patients independently of the blood pressure

Aldosterone can have an adverse effect on the heart, independent of arterial

blood pressure and angiotensin II, including a vascular inflammatory

response, myocyte necrosis, fibrosis, and hypertrophy.

In this issue of Hypertension, Vasan et al

their remarkable results from the Framingham Heart Study regarding the

gender-specific relations of serum aldosterone to echocardiographic indices

of cardiac structure and function in a large community-based sample of 2820

subjects (58% women, 42% men) free of myocardial infarction and heart

failure.

Their important findings demonstrated that serum aldosterone was positively

associated with a left ventricular geometric pattern suggestive for

concentric remodeling in women but not in men.

These recent findings regarding gender differences with aldosterone and left

ventricular remodeling emerge once again, validating the exploration of

gender-based differences in early cardiovascular disease as a basis for

clinical strategies to improve outcomes for women in the future.

Val

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