Document Detail

Neurohormonal markers of clinical outcome in cardiovascular disease: is endothelin the best one?
MedLine Citation:
PMID:  9736439     Owner:  NLM     Status:  MEDLINE    
Endothelin-1 (ET-1) is the most potent vasoconstrictor yet described. The active 21-amino-acid peptide is derived from the conversion of the inactive precursor "Big ET-1" by an enzyme called endothelin-converting enzyme. In addition to its potent action as a vasoconstrictor, endothelin promotes growth and proliferation of smooth muscle and myocardial hypertrophy. ET-1 levels are elevated in acute myocardial infarction (MI), atherosclerosis, renal failure, diabetes, pulmonary hypertension, and congestive heart failure (CHF). ET-1 levels correlate extremely well with the seriousness of the pathophysiologic condition. ET-1 levels at 72 h post MI accurately predict long-term survival. In patients with heart failure, ET-1 levels also predict long-term outcome, with the prognosis being severely compromised in patients with elevated ET-1 levels. Levels of plasma big ET-1 have been demonstrated to predict 1-year mortality and have been shown to be a better predictor of 1-year outcome than plasma atrial natriuretic peptide and norepinephrine, NYHA class, age, and echocardiographic left ventricular parameters. Although a small number of studies have reported beneficial effects of ACE inhibitors on ET-1 levels in animal models, most reports in humans have not found an effect of ACE inhibitors on ET-1 levels. Only one ACE inhibitor, fosinopril, has been shown to be effective in normalizing ET-1 levels in clinically relevant situations, such as the long-term study of patients with CHF. This observation may point to a superior role of fosinopril compared with other ACE inhibitors in CHF patients and may indicate beneficial effects of fosinopril beyond blood pressure control.
J C Monge
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  32 Suppl 2     ISSN:  0160-2446     ISO Abbreviation:  J. Cardiovasc. Pharmacol.     Publication Date:  1998  
Date Detail:
Created Date:  1998-11-17     Completed Date:  1998-11-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  S36-42     Citation Subset:  IM    
St. Michael's Hospital and University of Toronto, Ontario, Canada.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / pharmacology
Biological Markers
Cardiovascular Diseases / blood*,  drug therapy
Endothelin-1 / blood*
Heart Failure / blood,  drug therapy
Receptors, Endothelin / analysis
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Biological Markers; 0/Endothelin-1; 0/Receptors, Endothelin

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