Effect of eplerenone on aldosterone and von Willebrand factor levelsin patients with myocardial infarction and chronic kidney disease

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.1.239214

Keywords:

myocardial infarction, aldosterone, von Willebrand factor, renal dysfunction

Abstract

Aim: to study the levels of aldosterone and von Willebrand factor (VWF) in patients with Q-wave acute myocardial infarction (Q-AMI) and underling chronic kidney disease (CKD) using aldosterone antagonists.

Materials and methods. The study group consisted of 106 patients with renal dysfunction who were hospitalized for acute Q-AMI. Serum levels of neurohumoral parameters (aldosterone and VWF) were determined in all the patients by enzyme-linked immunosorbent assay kits.

Results. Reduction in the aldosterone levels was found in patients with Q-AMI and stage 2 CKD from 245.08 ± 17.38 pmol/l to 195.15 ± 13.82 pmol/l (P < 0.05;) who received spironolactone and from 275.59 ± 23.43 to 169.37 ± 24.46 pmol/l (P < 0.001) with eplerenone usage. Patients with stage 1 CKD showed a decreasing trend in aldosterone levels when using spironolactone (from 238.04 ± 20.37 pmol/l to 200.78 ± 9.15 pmol/l), and significantly decreased aldosterone levels when receiving eplerenone (from 229.77 ± 13.76 pmol/l to 156.76 ± 5.76 pmol/l; P < 0.05). The serum concentration of VWF in stage 2 CKD patients was changed insignificantly on spironolactone therapy (from 0.99 ± 0.13 mg/l to 1.13 ± 0.06 mg/l) and it was significantly decreased in the eplerenone group – from 1.29 ± 0.19 mg/l to 0.71 ± 0.14 mg/l (P < 0.05). In stage 1 CKD patients, the concentration of VWF was not decreased significantly with the use of spironolactone (from 1.22 ± 0.13 mg/l to 1.03 ± 0.06 mg/l), but it was decreased significantly when receiving eplerenone (from 1.14 ± 0.09 mg/l to 0.79 ± 0.08 mg/l; P < 0.05). The data obtained indicate the significantly higher probability of declining both aldosterone (t = 2.91; P < 0.01) and VWF (t = 2.59; P < 0.01) with the use of eplerenone in the complex treatment as compared to the spironolactone administration.

Conclusions. The effect of eplerenone to decrease the concentration of aldosterone and VWF is significantly greater than that of spironolactone, especially in AMI patients with stage 2 CKD.

 

Author Biographies

V. K. Tashchuk, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine, Physical Rehabilitation and Sports Medicine

O. S. Polianska, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, PhD, DSc, Professor of the Department of Internal Medicine, Physical Rehabilitation and Sports Medicine

O. I. Hulaha, Bukovinian State Medical University, Chernivtsi, Ukraine

MD, Assistant of the Department of Internal Medicine, Physical Rehabilitation and Sports Medicine

References

Law, J. P., Pickup, L., Townend, J. N., & Ferro, C. J. (2020). Anticoagulant strategies for the patient with chronic kidney disease. Clinical Medicine, 20(2), 151-155. https://doi.org/10.7861/clinmed.2019-0445

Pilmore, H. L., Xiong, F., Choi, Y., Poppe, K., Lee, M., Legget, M., & Kerr, A. (2020). Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS-QI 44). Nephrology, 25(7), 535-543. https://doi.org/10.1111/nep.13703

Kaesler, N., Babler, A., Floege, J., & Kramann, R. (2020). Cardiac Remodeling in Chronic Kidney Disease. Toxins, 12(3), Article 161. https://doi.org/10.3390/toxins12030161

Sueta, D., Yamamoto, E., & Tsujita, K. (2020). Mineralocorticoid Receptor Blockers: Novel Selective Nonsteroidal Mineralocorticoid Receptor Antagonists. Current Hypertension Reports, 22(3), Article 21. https://doi.org/10.1007/s11906-020-1023-y

Pantelidis, P., Sideris, M., Viigimaa, M., Avranas, K., Deligkaris, P., Zografou, I., & Lovic, D. (2018). The Mechanisms of Actions of Aldosterone and its Antagonists in Cardiovascular Disease. Current Pharmaceutical Design, 24(46), 5491-5499. https://doi.org/10.2174/1381612825666190215100502

Sundaram, V., Rothnie, K., Bloom, C., Zakeri, R., Sahadevan, J., Singh, A., Nagai, T., Potts, J., Wedzicha, J., Smeeth, L., Simon, D., Timmis, A., Rajagopalan, S., & Quint, J. K. (2020). Impact of comorbidities on peak troponin levels and mortality in acute myocardial infarction. Heart, 106(9), 677-685. https://doi.org/10.1136/heartjnl-2019-315844

Jagieła, J., Bartnicki, P., & Rysz, J. (2020). Selected cardiovascular risk factors in early stages of chronic kidney disease. International Urology and Nephrology, 52(2), 303-314. https://doi.org/10.1007/s11255-019-02349-1

Beygui, F., Van Belle, E., Ecollan, P., Machecourt, J., Hamm, C. W., Lopez De Sa, E., Flather, M., Verheugt, F., Vicaut, E., Zannad, F., Pitt, B., & Montalescot, G. (2018). Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction. Heart, 104(22), 1843-1849. https://doi.org/10.1136/heartjnl-2018-312950

Hori, Y., Touei, D., Saitoh, R., Yamagishi, M., Kanai, K., Hoshi, F., & Itoh, N. (2017). The Aldosterone Receptor Antagonist Eplerenone Inhibits Isoproterenol-Induced Collagen-I and 11β-HSD1 Expression in Rat Cardiac Fibroblasts and the Left Ventricle. Biological and Pharmaceutical Bulletin, 40(10), 1716-1723. https://doi.org/10.1248/bpb.b17-00291

Olivier, A., Pitt, B., Girerd, N., Lamiral, Z., Machu, J. L., McMurray, J., Swedberg, K., van Veldhuisen, D. J., Collier, T. J., Pocock, S. J., Rossignol, P., Zannad, F., & Pizard, A. (2017). Effect of eplerenone in patients with heart failure and reduced ejection fraction: potential effect modification by abdominal obesity. Insight from the EMPHASIS-HF trial. European Journal of Heart Failure, 19(9), 1186-1197. https://doi.org/10.1002/ejhf.792

Gromotowicz-Poplawska, A., Marcinczyk, N., Misztal, T., Golaszewska, A., Aleksiejczuk, M., Rusak, T., & Chabielska, E. (2019). Rapid effects of aldosterone on platelets, coagulation, and fibrinolysis lead to experimental thrombosis augmentation. Vascular Pharmacology, 122-123, Article 106598. https://doi.org/10.1016/j.vph.2019.106598

Gromotowicz-Poplawska, A., Stankiewicz, A., Kramkowski, K., Gradzka, A., Wojewodzka-Zelezniakowicz, M., Dzieciol, J., Szemraj, J., & Chabielska, E. (2016). The acute prothrombotic effect of aldosterone in rats is partially mediated via angiotensin II receptor type 1. Thrombosis Research, 138, 114-120. https://doi.org/10.1016/j.thromres.2015.12.008

Spencer, S., Wheeler-Jones, C., & Elliott, J. (2020). Aldosterone and the mineralocorticoid receptor in renal injury: A potential therapeutic target in feline chronic kidney disease. Journal of Veterinary Pharmacology and Therapeutics, 43(3), 243-267. https://doi.org/10.1111/jvp.12848

Lainscak, M., Pelliccia, F., Rosano, G., Vitale, C., Schiariti, M., Greco, C., Speziale, G., & Gaudio, C. (2015). Safety profile of mineralocorticoid receptor antagonists: Spironolactone and eplerenone. International Journal of Cardiology, 200, 25-29. https://doi.org/10.1016/j.ijcard.2015.05.127

Yamamoto, M., Seo, Y., Ishizu, T., Nishi, I., Hamada-Harimura, Y., Machino-Ohtsuka, T., Higuchi, H., Sai, S., Nakatsukasa, T., Sugano, A., Baba, M., Obara, K., & Aonuma, K. (2019). Comparison of effects of aldosterone receptor antagonists spironolactone and eplerenone on cardiovascular outcomes and safety in patients with acute decompensated heart failure. Heart and Vessels, 34(2), 279-289. https://doi.org/10.1007/s00380-018-1250-1

Published

2022-01-26

How to Cite

1.
Tashchuk VK, Polianska OS, Hulaha OI. Effect of eplerenone on aldosterone and von Willebrand factor levelsin patients with myocardial infarction and chronic kidney disease. Zaporozhye medical journal [Internet]. 2022Jan.26 [cited 2024Mar.28];24(1):13-6. Available from: http://zmj.zsmu.edu.ua/article/view/239214

Issue

Section

Original research