Abstract-The renin-angiotensin-aldosterone-system appears to be involved in the development of cardiac fibrosis in rodents, characterized by nonepithelial cell proliferation and changes in the extracellular matrix. The aim of our study was to investigate the effect of high aldosterone concentrations on the proliferation of human cardiac interstitial cells in vitro. In addition, the effect of D-glucose as another risk factor for fibrosis, eg, in the diabetic heart, was investigated. Human cardiac myofibroblast cultures were established, and growth rates were measured by WST-1 assay in fetal calf serum-free Dulbecco's modified Eagle's medium (DMEM). Cells in culture showed a significant increase in number between 24 to 72 hours of cultivation under basal conditions (DMEM, 10% fetal calf serum). Aldosterone at high concentrations (10 Ϫ8 and 10 Ϫ7 mol/L) significantly (PϽ0.01) increased the proliferation of cultured cardiac myofibroblasts. Comparable effects were observed after incubation of the cells with high D-glucose concentrations (15 and 25 mmol/L, PϽ0.01). No additive growth stimulation was evident when the cells were incubated in medium containing both aldosterone and D -glucose. These results suggest a role for aldosterone and glucose in mediating the cardiac fibrosis through stimulation of myofibroblast growth in patients with dysregulated renin-angiotensin-aldosterone-system (especially hyperaldosteronism) and impaired glucose homeostasis. R ecent clinical studies demonstrate a reduction in cardiovascular mortality in patients with heart failure treated with ACE inhibitors, angiotensin II blockers, and aldosterone antagonists. These effects were also seen in patients with diabetes mellitus. Ramipril reduced not only cardiac failure and myocardial infarction but also diabetic complications and the incidence of new manifestations of diabetic disease. 1 In the RALES trial (Randomized Aldactone Evaluation Study), spironolactone added to standard therapy (ACE inhibitors, loop diuretics, digoxin, etc) had a beneficial effect on mortality in patients with congestive heart failure, with a 30% reduction in mortality seen in the spironolactone group. 2 This effect was only significant in patients with elevated serum levels of collagen synthesis markers, suggesting limitation of excessive extracellular matrix turnover as one mechanism contributing to the beneficial effect of spironolactone. 2