eplerenone and Atherosclerosis

Primary aldosteronism (PA) is associated with a higher rate of cardiovascular events than essential hypertension. Although adrenalectomy has been reported to reduce carotid intima-media thickness (IMT) in patients with PA, the effects of the selective aldosterone blocker, eplerenone, on vascular damage in these patients remains unclear. To evaluate the effects of eplerenone on vascular status in PA patients, we sequentially measured carotid IMT (using computer software to calculate an average IMT for accurate and reproducible evaluation) in 22 patients including 8 patients treated by unilateral adrenalectomy and 14 patients treated with eplerenone for 12 months. Patients who underwent adrenalectomy showed significant reductions in aldosterone concentration (from 345 ± 176 pg/mL to 67 ± 34 pg/mL; P<0.01) and IMT (from 0.67 ± 0.07 mm to 0.63 ± 0.09 mm; P<0.05) 6 months after surgery. Patients treated with eplerenone showed significant reductions in IMT from baseline (0.75 ± 0.10 mm) to 6 (0.71 ± 0.11 mm; P<0.05) and 12 (0.65 ± 0.09 mm; P<0.01) months, although plasma aldosterone level increased significantly, from 141 ± 105 pg/mL to 207 ± 98 pg/mL (P<0.05). Eplerenone treatment of patients with PA reduces blood pressure, increases serum potassium level, and improves vascular status. Carotid IMT may be a useful marker for evaluating the effectiveness of eplerenone in patients with PA.

Topics: Adrenalectomy; Adult; Aged; Aldosterone; Atherosclerosis; Biomarkers; Carotid Intima-Media Thickness; Drug Monitoring; Eplerenone; Female; Follow-Up Studies; Humans; Hyperaldosteronism; Hypertension; Hypokalemia; Japan; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Potassium; Reproducibility of Results; Risk; Spironolactone

A low-sodium diet (LSD) was shown to increase both angiotensin II (AngII) and aldosterone levels, and to accelerate atherosclerosis in apolipoprotein E-deficient (E0) mice. The aim of the present study was to examine whether accelerated atherosclerosis in E0 mice fed a LSD is mediated by aldosterone, using the mineralocorticoid receptor blocker, eplerenone (Epl).. Mice were divided into three groups: normal diet (ND), LSD and LSD treated with Epl at 100 mg/kg per day (LSD+Epl) for 10 weeks. LSD significantly enhanced plasma renin and aldosterone levels, which were further increased in mice fed LSD+Epl. The aortic lesion area increased three-fold with LSD, while LSD+Epl significantly reduced the lesion area to values similar to ND. Serum and peritoneal macrophages obtained from LSD-fed mice exhibited pro-atherogenic properties including increased inflammation, oxidation and cholesterol accumulation, which were inhibited in mice fed LSD+Epl. In a J774A.1 macrophage-like cell line stimulated with lipopolysaccharide, Epl was shown to have a direct anti-inflammatory effect.. In E0 mice, Epl inhibited LSD-accelerated atherosclerosis, despite the elevation of renin and aldosterone levels. It is therefore suggested that the atherogenic action of LSD could be mediated, at least in part, by activation of the mineralocorticoid receptor. In addition, eplerenone may have direct anti-inflammatory actions.

Topics: Aldosterone; Animals; Aorta; Apolipoproteins E; Atherosclerosis; Biomarkers; Diet, Sodium-Restricted; Eplerenone; Humans; Inflammation; Macrophages, Peritoneal; Mice; Mineralocorticoid Receptor Antagonists; Receptors, Mineralocorticoid; Renin; Renin-Angiotensin System; Spironolactone

The beneficial effects of eplerenone, a specific mineralocorticoid receptor blocker, were previously demonstrated in early atherosclerosis (ATS). The aim of the present study was to evaluate the effect of eplerenone in advanced versus early ATS. Apolipoprotein E knockout mice aged 16 or 32 weeks were randomly divided into eplerenone (100 mg·kg·d) or vehicle treatment for 14 weeks. Eplerenone reduced atherosclerotic lesion size by 51% only in early ATS. In peritoneal macrophages obtained from these mice, eplerenone reduced messenger RNA expression of pro-inflammatory markers, interleukin 6, tumor necrosis factor α, monocyte chemotactic protein 1, and increased anti-inflammatory marker arginase 1 to a greater extent in early compared with advanced ATS. These changes correspond to macrophage polarization toward alternative inflammatory phenotype. Messenger RNA expression of the mineralocorticoid receptor and aldosterone synthase were also reduced by eplerenone to a greater extent in early ATS, and these might increase the sensitivity of macrophages to mineralocorticoid blockade in early ATS. The results of the present study point to the benefits of early initiation of treatment with eplerenone in reducing experimental ATS.

Topics: Animals; Aorta, Thoracic; Aortic Diseases; Apolipoproteins E; Atherosclerosis; Cytochrome P-450 CYP11B2; Cytokines; Disease Models, Animal; Disease Progression; Eplerenone; Inflammation Mediators; Lipids; Macrophages, Peritoneal; Male; Mice; Mice, Knockout; Mineralocorticoid Receptor Antagonists; Plaque, Atherosclerotic; Receptors, Mineralocorticoid; RNA, Messenger; Spironolactone

Mineralocorticoid receptor (MR) activation is proinflammatory and proatherogenic. Antagonism of MR improves survival in humans with congestive heart failure caused by atherosclerotic disease. In animal models, activation of MR exacerbates atherosclerosis. The enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) prevents inappropriate activation of the MR by inactivating glucocorticoids in mineralocorticoid-target tissues. To determine whether glucocorticoid-mediated activation of MR increases atheromatous plaque formation, we generated Apoe(-/-)/11β-HSD2(-/-) double-knockout (E/b2) mice. On chow diet, E/b2 mice developed atherosclerotic lesions by 3 months of age, whereas Apolipoprotein E (Apoe(-/-)) mice remained lesion free. Brachiocephalic plaques in 3-month-old E/b2 mice showed increased macrophage and lipid content and reduced collagen content compared with similar sized brachiocephalic plaques in 6-month-old Apoe(-/-) mice. Crucially, treatment of E/b2 mice with eplerenone, an MR antagonist, reduced plaque development and macrophage infiltration while increasing collagen and smooth muscle cell content without any effect on systolic blood pressure. In contrast, reduction of systolic blood pressure in E/b2 mice using the epithelial sodium channel blocker amiloride produced a less-profound atheroprotective effect. Vascular cell adhesion molecule 1 expression was increased in the endothelium of E/b2 mice compared with Apoe(-/-) mice. Similarly, aldosterone increased vascular cell adhesion molecule 1 expression in mouse aortic endothelial cells, an effect mimicked by corticosterone only in the presence of an 11β-HSD2 inhibitor. Thus, loss of 11β-HSD2 leads to striking atherogenesis associated with activation of MR, stimulating proinflammatory processes in the endothelium of E/b2 mice.

Topics: 11-beta-Hydroxysteroid Dehydrogenase Type 2; Amiloride; Animals; Aorta; Apolipoproteins E; Atherosclerosis; Cell Line; Endothelium, Vascular; Eplerenone; Gene Expression Regulation, Enzymologic; Inflammation; Male; Mice; Mice, Knockout; Mineralocorticoid Receptor Antagonists; Sodium Channel Blockers; Spironolactone

It has been suggested that aldosterone, with its known pro-inflammatory and profibrotic actions, may play a key role in the development and progression of atherosclerosis.. In this study, the ability of aldosterone antagonism to reduce atherosclerosis in experimental diabetes was assessed. Diabetes was induced in ApoE knockout mice with streptozotocin, and the mice were treated with the specific aldosterone antagonist, eplerenone, in their feed over 20 weeks (approximately 200 mg/kg per day).. En face analysis revealed that eplerenone treatment was unable to attenuate atherosclerosis as assessed by percentage lesion area quantitation in the aortae of these mice compared with untreated diabetic mice (diabetic, 10.7 +/- 1.1; diabetic + eplerenone, 8.8 +/- 1.2%). In contrast, we observed a significant, more than 50% decrease in percentage of plaque area in the nondiabetic control groups. Despite this lack of effect in the diabetic mice, eplerenone treatment was associated with reduced cytosolic superoxide production. However, aortic transcript levels of key molecules implicated in diabetes-associated atherogenesis, such as monocyte chemoattractant protein-1 and vascular cell adhesion molecule-1, were not significantly attenuated by eplerenone.. These findings suggest that eplerenone treatment may not be as antiatherosclerotic in the diabetic context.

Topics: Animals; Apolipoproteins E; Atherosclerosis; Blood Pressure; Diabetes Mellitus, Experimental; Enzyme-Linked Immunosorbent Assay; Eplerenone; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Mineralocorticoid Receptor Antagonists; Oxidative Stress; Polymerase Chain Reaction; Renin-Angiotensin System; Spironolactone; Superoxides

Angiotensin II and aldosterone both promote endothelial dysfunction and atherosclerosis. We investigated the effect of a combination of eplerenone, a selective aldosterone antagonist, and enalapril, an angiotensin-converting enzyme inhibitor, on NO bioavailability and spontaneous atherosclerotic changes. Twenty-four myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits were treated with vehicle (control), eplerenone (50 mg/kg per day), enalapril (3 mg/kg per day), or eplerenone plus enalapril for 8 weeks (n=6 in each group). After treatment, acetylcholine-induced NO production was measured as a surrogate for endothelium-protective function, and vascular peroxynitrite (a product of superoxide and NO) was measured to assess dysfunctional endothelial NO synthase activity. Plaque area was quantified by histology. Intra-aortic infusion of acetylcholine produced an increase in plasma NO concentration that was significantly higher with all of the drug treatments compared with the control. Eplerenone and enalapril, in combination, increased acetylcholine-induced NO by 7.9 nM, which was significantly higher than with either eplerenone or enalapril alone. Vascular peroxynitrite was significantly higher in the control group (1.3 pmol/mg of protein) and significantly lower with combination treatment (0.4 pmol/mg of protein) compared with the enalapril or eplerenone group. The highest tetrahydrobiopterin levels were observed after cotreatment with eplerenone and enalapril. Histology of the thoracic aorta showed a significantly decreased plaque area with combination therapy compared with monotherapy. Combined treatment with a selective aldosterone antagonist and an angiotensin-converting enzyme inhibitor has additive protective effects on endothelial function and on atherosclerotic changes via decreased nitrosative stress.

Topics: Acetylcholine; Aldosterone; Angiotensin-Converting Enzyme Inhibitors; Animals; Aorta, Thoracic; Atherosclerosis; Biological Availability; Blood Pressure; Cholesterol; Enalapril; Eplerenone; Mineralocorticoid Receptor Antagonists; Nitric Oxide; Peptidyl-Dipeptidase A; Peroxynitrous Acid; Rabbits; Reactive Oxygen Species; Spironolactone

Angiotensin II contributes to atherogenesis, mainly through oxidative stress and inflammation. Recent data suggest that aldosterone is implicated in some effects of angiotensin II. We hypothesized that aldosterone could directly contribute to oxidative stress and atherosclerotic lesion formation.. Male apolipoprotein E-deficient mice 6 weeks of age were placed on a normal diet or 1.25% high-cholesterol diet. After 6 weeks of the high-cholesterol diet, a marked increase in atherosclerotic lesion formation was observed in the aorta, accompanied by significant elevation of plasma cholesterol level. Production of superoxide anion and expression of NAD(P)H oxidase subunit p47phox, tumor necrosis factor-alpha, and monocyte chemoattractant protein-1 in the aorta were increased with the high-cholesterol diet. Eplerenone (1.67 g/kg in high-cholesterol diet) did not affect blood pressure or plasma cholesterol but decreased the atherosclerotic area by nearly 70% (P<0.05), associated with attenuation of oxidative stress and inflammatory response. Valsartan (0.5 mg/kg per day) also decreased the atherosclerotic lesion, whereas coadministration of valsartan and eplerenone further decreased it. Moreover, aldosterone (0.1 micromol/L) enhanced NADPH oxidase activity in cultured vascular smooth muscle cells.. These results suggest that aldosterone may play a critical role in atherogenesis subsequent to oxidative stress in part independent of angiotensin II-mediated signaling, and that eplerenone could prevent atherosclerosis by attenuating oxidative stress and inflammation.

Topics: Aldosterone; Animals; Aorta; Atherosclerosis; Blood Pressure; Cells, Cultured; Chemokine CCL2; Cholesterol, Dietary; Diet, Atherogenic; Enzyme Activation; Eplerenone; Inflammation; Male; Mice; Muscle, Smooth, Vascular; NADPH Oxidases; Oxidative Stress; Spironolactone; Superoxides; Tetrazoles; Tumor Necrosis Factor-alpha; Valine; Valsartan

Aldosterone may be involved in the pathogenesis of atherosclerosis. We investigated the effect of eplerenone, a selective mineralocorticoid receptor blocker, on atherosclerosis in monkeys fed a high-cholesterol diet. Monkeys fed a high-cholesterol diet for 9 months were divided into 3 groups: those treated with a low dose of eplerenone (30 mg/kg per day); those treated with a high dose of eplerenone (60 mg/kg per day); and the placebo-treated group. The normal group consisted of monkeys fed a normal diet. There were no significant differences in blood pressure and cholesterol levels between the placebo- and eplerenone-treated groups. On the other hand, monocyte chemoattractant protein-1 and malondialdehyde-modified LDL were significantly higher in the placebo-treated group than in the normal group, whereas they were suppressed in the eplerenone-treated groups. The ratio of intimal volume to total volume by intravascular ultrasound analysis imaging of the aortas was dose-dependently lower in the eplerenone-treated groups than in the placebo-treated group. Acetylcholine-induced vasorelaxation was significantly weaker in the placebo-treated group than in the normal group, but the vasorelaxation was strengthened in the eplerenone-treated groups. A significant upregulation of angiotensin-converting enzyme activity was observed in the placebo-treated group, but the activity was suppressed in the eplerenone-treated groups. In conclusion, eplerenone may strengthen the endothelium-dependent relaxation and suppress angiotensin-converting enzyme activity in the vasculature, thus preventing the development of atherosclerosis in nonhuman primates.

Topics: Acetylcholine; Animals; Aorta; Atherosclerosis; Carotid Arteries; Chemokine CCL2; Cholesterol, Dietary; Cholesterol, HDL; Cholesterol, LDL; Dose-Response Relationship, Drug; Eplerenone; Lipid Metabolism; Lipoproteins, LDL; Macaca fascicularis; Male; Malondialdehyde; Peptidyl-Dipeptidase A; Renin; Spironolactone; Tunica Intima; Ultrasonography; Vasodilation

Topics: Aldosterone; Animals; Atherosclerosis; Eplerenone; Humans; Mineralocorticoid Receptor Antagonists; Receptors, Mineralocorticoid; Spironolactone