Serum Aldosterone Concentration, Blood Pressure, and Coronary Artery Calcium

Aldosterone is a steroid hormone regulating fluid and electrolyte homeostasis and is known to increase the risk of atherosclerosis. In this study, we examined the associations of serum aldosterone concentrations with subclinical atherosclerosis and all-cause mortality. This study included 948 adults aged 46 to 88 years from the MESA (Multi-Ethnic Study of Atherosclerosis) with measurements of serum aldosterone and plasma renin activity and not taking antihypertensive medications. Coronary calcification was longitudinally assessed using Agatston coronary artery calcium score from computed tomography scans. All-cause mortality was ascertained from the medical record. The average age (SD) was 62.3 (9.4) years and 53% were male. Among 700 subjects who had follow-up coronary artery calcium score (median follow-up of 6.4 years), higher aldosterone levels (per 100 pg/mL) were associated with higher coronary artery calcium (relative ratio, 1.17 [95% CI, 1.04–1.32]), with the association being stronger in individuals with suppressed plasma renin activity (≤0.5 μg/L/hr). Systolic or diastolic blood pressure mediated around 45% of the total effect of aldosterone on coronary artery calcium. Over a median follow-up of 12.5 years (120 deaths identified among 948 subjects), aldosterone was associated with the increased risk of all-cause mortality when plasma renin activity was suppressed; hazard ratio per 100 pg/mL, 1.70 (95% CI, 1.10–2.63). In this study, we found that higher aldosterone levels were associated with the increased risk of subclinical coronary atherosclerosis and all-cause mortality particularly when renin was suppressed. Our findings indicate the importance of aldosterone levels (even within the reference range) with respect to the cardiovascular system and overall health.

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Abstract 12435: Coronary Artery Calcium Score of Zero Predicts Lower All-Cause Mortality Over a Long-Term Follow-Up

Circulation ◽

10.1161/circ.130.suppl_2.12435 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Joseph T Knapper ◽

Taylor Lebeis ◽

Geoff Southmayd ◽

Pratik Sandesara ◽

Michael J Blaha ◽

...

Keyword(s):

Coronary Artery ◽

General Population ◽

Coronary Artery Calcium ◽

Statistical Significance ◽

Hazard Modeling ◽

Increased Risk ◽

All Cause Mortality ◽

Chd Risk Factors

Background: Coronary artery calcium (CAC) scoring has been shown in numerous studies to correlate well with adverse cardiovascular outcomes. In particular, a CAC score of zero has been linked with excellent survival. However, the majority of studies report only short-term follow-up results, and there is little data available on the long-term significance of a zero CAC score. Methods: A total of 9,074 (53±10 years, 60% male) consecutive asymptomatic individuals, free of known coronary heart disease (CHD), underwent CAC Agatston scoring for cardiovascular risk assessment. CHD risk factors were prospectively obtained by patient interview. Unadjusted and risk-factor adjusted Cox proportional hazard modeling was used to estimate time to all-cause mortality (median follow-up=14.7 years) by CAC subsets and was compared to general population mortality estimates. Results: Of all patients enrolled, 4,537 (50.0%) had a CAC score of zero. Annual all-cause mortality, based on adjusted Cox hazard modeling, was significantly lower in both men and women with a CAC score of zero than would be predicted for the general population (see Figure ). The median reduction in projected annual mortality was 68.4% for men and 51.2% for women, with the degree of mortality reduction increasing with age. Compared to a CAC score of zero, even a low-risk CAC score of 1-10 was associated with an increased risk of all-cause mortality (HR = 4.19, 1.97, 2.44 * , 1.82 * , and 1.70 * at 1, 3, 5, 10, and 15 years of follow-up, respectively), though importantly this effect did not reach statistical significance until 5 years of follow-up. Conclusion: A CAC score of zero is associated with a markedly decreased risk of all-cause mortality compared to the general population, and its significance increases with both age and length of follow-up.

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125 Increased plasma renin activity during wake in a repetitive sleep restriction protocol

SLEEP ◽

10.1093/sleep/zsab072.124 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A51-A51

Author(s):

Huan Yang ◽

Michael Vazquez ◽

Monika Haack ◽

Janet Mullington

Keyword(s):

Renal Function ◽

Plasma Renin Activity ◽

Impaired Renal Function ◽

Plasma Renin ◽

Renin Activity ◽

Sleep Restriction ◽

Science Center ◽

Percent Change ◽

Recovery Sleep ◽

Increased Risk

Abstract Introduction Insufficient sleep is associated with an increased risk of hypertension. It is well established that long-term BP regulation is modulated by the renin-angiotensin-aldosterone system (RAAS) and chronic kidney disease is a strong independent risk factor for development of cardiovascular disease. This study investigated the biomarkers of RAAS and renal function during repetitive exposures to controlled, experimental sleep restriction (SR). We hypothesized an upregulation of RAAS and increased markers of impaired renal function. Methods Twenty-one healthy participants (11 women, average age 31±2 years) completed the 22-day in-hospital SR protocol: permitted 4h of sleep/night from 0300-0700 for 3 nights followed by a recovery sleep, repeated 4 times. Blood samples were collected and plasma renin activity (PRA) was assessed in the morning (7:05am) and in the evening before bedtime (22:45pm) at baseline, experimental days (3rd day of each of the 4 blocks), and recovery. Urinary albumin to creatinine ratio (ACR) was measured from 24-h urinary collection at baseline, first and fourth SR blocks. Estimated glomerulus filtration rate (eGFR) was calculated based on the serum cystatin C levels at baseline and last block of SR. Results Percent change of evening PRA significantly increased during 4 blocks of SR and recovery (SR effect p=0.039), but not morning PRA (SR effect p=0.34). Specifically, evening PRA increased up to 98.4% in the first (p<0.01), 61.3% in the second (p=0.04) SR blocks, and 57.5% (p=0.05) in recovery. Urinary ACR showed no significant changes during first or fourth SR blocks (SR effect p=0.28). In addition, eGFR did not change in the fourth SR block compared to BL (paired t-test, p=0.27). Conclusion We did not see increased markers of impaired renal function (ACR or eGFR). Rather, short-term repetitive exposures to SR significantly increased percent change of PRA measured before bedtime, and evening PRA did not return to BL level during recovery. Our results suggested that sleep deficiency may contribute to hypertension through upregulation of RAAS during wake time. Support (if any) SRSF (CDA to Huan Yang), NIH (R01HL106782 to Dr. Janet Mullington), Harvard Catalyst, Harvard Clinical and Translational Science Center (UL1TR001102).

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Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients

Journal of Clinical Medicine ◽

10.3390/jcm10061220 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1220

Author(s):

Thomas Senoner ◽

Fabian Plank ◽

Christoph Beyer ◽

Christian Langer ◽

Katharina Birkl ◽

...

Keyword(s):

Gender Differences ◽

Coronary Artery ◽

Cardiovascular Mortality ◽

Coronary Artery Calcium ◽

Coronary Artery Calcium Score ◽

Calcium Score ◽

Plaque Burden ◽

Term Outcome ◽

Long Term Outcome ◽

All Cause Mortality

Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile of CTA in patients with a CACS of zero. Methods: A total of 1451 low- to intermediate-risk patients (53 ± 11 years; 51% females) with CACS <1.0 Agatston units (AU) who underwent CTA and CACS were included. Males and females were 1:1 propensity score-matched. CTA was evaluated for stenosis severity (Coronary Artery Disease – Reporting and Data System (CAD-RADS) 0–5: minimal <25%, mild 25–49%, moderate 50–69%, severe ≥70%), mixed-plaque burden (G-score), and high-risk plaque (HRP) criteria (low-attenuation plaque, spotty calcification, napkin-ring sign, and positive remodeling). All-cause mortality, cardiovascular mortality, and major cardiovascular events (MACEs) were collected. Results: Among the patients, 88.8% had a CACS of 0 and 11.2% had an ultralow CACS of 0.1–0.9 AU. More males than females (32.1% vs. 20.3%; p < 0.001) with a CACS of 0 had atherosclerosis, while, among those with an ultralow CACS, there was no difference (88% vs. 87.1%). Nonobstructive CAD (25.9% vs. 16.2%; p < 0.001), total plaque burden (2.2 vs. 1.4; p < 0.001), and HRP were found more often in males (p < 0.001). After a follow-up of mean 6.6 ± 4.2 years, all-cause mortality was higher in females (3.5% vs. 1.8%, p = 0.023). Cardiovascular mortality and MACEs were low (0.2% vs. 0%; p = 0.947 and 0.3% vs. 0.6%; p = 0.790) for males vs. females, respectively. Females were more often symptomatic for chest pain (70% vs. 61.6%; p = 0.004). (4) Conclusions: In patients with a CACS of 0, males had a higher prevalence of atherosclerosis, a higher noncalcified plaque burden, and more HRP criteria. Nonetheless, females had a worse long–term outcome and were more frequently symptomatic.

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The relationship between plasma renin activity and serum lipid profiles in patients with primary arterial hypertension

Journal of the Renin-Angiotensin-Aldosterone System ◽

10.1177/1470320318810022 ◽

2018 ◽

Vol 19 (4) ◽

pp. 147032031881002 ◽

Cited By ~ 3

Author(s):

Tomasz Pizoń ◽

Marek Rajzer ◽

Wiktoria Wojciechowska ◽

Małgorzata Wach-Pizoń ◽

Tomasz Drożdż ◽

...

Keyword(s):

Plasma Renin Activity ◽

Arterial Hypertension ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Plasma Renin ◽

Serum Levels ◽

Renin Activity ◽

Serum Aldosterone ◽

Primary Arterial Hypertension ◽

Aldosterone To Renin Ratio

Introduction: The aim of the study was to evaluate clinical and biochemical differences between patients with low-renin and high-renin primary arterial hypertension (AH), mainly in reference to serum lipids, and to identify factors determining lipid concentrations. Materials and methods: In untreated patients with AH stage 1 we measured plasma renin activity (PRA) and subdivided the group into low-renin (PRA < 0.65 ng/mL/h) and high-renin (PRA ⩾ 0.65 ng/mL/h) AH. We compared office and 24-h ambulatory blood pressure, serum aldosterone, lipids and selected biochemical parameters between subgroups. Factors determining lipid concentration in both subgroups were assessed in regression analysis. Results: Patients with high-renin hypertension ( N = 58) were characterized by higher heart rate ( p = 0.04), lower serum sodium ( p < 0.01) and aldosterone-to-renin ratio ( p < 0.01), and significantly higher serum aldosterone ( p = 0.03), albumin ( p < 0.01), total protein ( p < 0.01), total cholesterol ( p = 0.01) and low-density lipoprotein cholesterol (LDL-C) ( p = 0.04) than low-renin subjects ( N = 39). In univariate linear regression, only PRA in the low-renin group was in a positive relationship with LDL-C ( R2 = 0.15, β = 1.53 and p = 0.013); this association remained significant after adjustment for age, sex, and serum albumin and aldosterone concentrations. Conclusions: Higher serum levels of total and LDL-C characterized high-renin subjects, but the association between LDL-C level and PRA existed only in low-renin primary AH.

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Plasma renin activity and serum aldosterone during prolonged physical strain

European Journal of Applied Physiology and Occupational Physiology ◽

10.1007/bf00426289 ◽

1985 ◽

Vol 54 (1) ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

P. K. Opstad ◽

O. �ktedalen ◽

A. Aakvaag ◽

F. Fonnum ◽

P. K. Lund

Keyword(s):

Plasma Renin Activity ◽

Plasma Renin ◽

Renin Activity ◽

Physical Strain ◽

Serum Aldosterone

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Abstract 031: Diastolic Blood Pressure, Coronary Artery Calcium, and Cardiac Outcomes in the Multi-ethnic Study of Atherosclerosis

Hypertension ◽

10.1161/hyp.70.suppl_1.031 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

John W McEvoy ◽

Faisal Rahman ◽

Mahmoud Al Rifai ◽

Michael Blaha ◽

Khurram Nasir ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Coronary Artery Calcium ◽

J Curve ◽

Increased Risk ◽

All Cause Mortality

Diastolic blood pressure (BP) has a J-curve relationship with coronary heart disease and death. Because this association is thought to reflect reduced coronary perfusion at low diastolic BP, our objective was to test whether the J-curve is most pronounced among persons with coronary artery calcium. Among 6,811 participants from the Multi-Ethnic Study of Atherosclerosis, we used Cox models to examine if diastolic BP category is associated with coronary heart disease events, stroke, and mortality. Analyses were conducted in the sample overall and after stratification by coronary artery calcium score. In multivariable-adjusted analyses, compared with diastolic BP of 80 to 89 mmHg (reference), persons with diastolic BP <60 mmHg had increased risk of coronary heart disease events (HR 1.69 [95% confidence interval 1.02-2.79]) and all-cause mortality (HR 1.48 [95% confidence interval 1.10-2.00]), but not stroke. After stratification, associations of diastolic BP <60 mmHg with events were present only among participants with coronary artery calcium >0. Diastolic BP <60 mmHg was not associated with events when coronary artery calcium was zero. We also found no interaction in the association between low diastolic BP and events based on race. In conclusion, diastolic blood pressure <60 mmHg was associated with increased risk of coronary heart disease events and all-cause mortality in the sample overall, but this association appeared strongest among individuals with elevated CAC; suggesting that added caution may be needed when pursuing intensive BP treatment targets among persons with subclinical atherosclerosis.

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430 Relation of blood pressure to coronary artery calcium and mortality

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.243 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I J Cho ◽

J H Lee ◽

S Y Choi ◽

E J Chun ◽

S H Park ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Artery ◽

Diastolic Blood Pressure ◽

Coronary Artery Calcium ◽

Multicenter Observational Study ◽

J Curve ◽

Increased Risk ◽

All Cause Mortality ◽

Study Population ◽

Artery Disease

Abstract Background Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC). Methods The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (> 300 and ≤ 300), and all-cause mortality was assessed. Results The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS > 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS > 300, whereas DBP < 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg. Conclusion Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.

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