Hear’s a rewritten version of the article, aiming for 100% unique phrasing while retaining the core data:
New study Suggests Subclinical Aldosterone Imbalance May Predict cardiovascular Risk
A recent investigation into the “E” cohort has shed light on a potential link between subtle imbalances in the renin-angiotensin-aldosterone system (RAAS) and the likelihood of experiencing critically important cardiovascular events. The research aimed to determine if subclinical primary aldosteronism (PA), a condition where the adrenal glands produce too much aldosterone without obvious symptoms, is associated with major adverse cardiovascular events (MACEs). MACEs in this study were defined as a combination of heart attack, stroke (both ischemic and hemorrhagic), hospital admission for heart failure, and death from cardiovascular causes.
The participants in this study had a median age of 56 years, with the vast majority (92%) identifying as White. Approximately half of the individuals (55%) presented with blood pressure readings exceeding 130/80 mm Hg. Notably, a small proportion of the cohort had diabetes (7%) or a prior history of cardiovascular disease (3%).
Median levels of aldosterone were recorded at 219 pmol/L (with an interquartile range of 163-299 pmol/L), and renin concentrations averaged 7.5 ng/L (IQR, 4.5-11.7 ng/L). The median aldosterone-to-renin ratio (ARR), a key indicator of PA, was 30 pmol/L per ng/L (IQR, 19-50 pmol/L per ng/L).
Over a median follow-up period of 10.8 years (IQR, 10.6-11.0 years), 2.8% of the participants experienced an incident MACE. The most frequent MACE was myocardial infarction, followed by stroke and hospitalization for heart failure. During the study, seven individuals died from cardiovascular causes, contrasting with 47 non-cardiovascular deaths.
The findings revealed that lower renin levels (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI],1.02-4.76) and a higher ARR (aHR, 2.43; 95% CI, 1.15-5.12) were both linked to an increased risk of MACE.However,the researchers did not find a significant association between higher aldosterone concentrations alone and MACE.
Further multivariable analysis indicated that a renin concentration of 4 ng/L or less was associated with a 2.1-fold greater risk of MACE (95% CI, 1.21-3.72). Similarly,an ARR of 70 pmol/L per ng/L or higher was linked to a twofold increase in MACE risk (aHR,2.03; 95% CI,1.09-3.80).
Individuals who met both of these criteria – representing about 21% of the study population – faced approximately 2.4 times the likelihood of experiencing a MACE (aHR, 2.42; 95% CI, 1.25-6.48). The researchers also noted that over 80% of participants with an ARR of 70 pmol/L per ng/L or more also had renin levels of 4 ng/L or lower. Importantly, these associations remained consistent nonetheless of blood pressure levels.
Dr. Hundemer, a lead researcher, suggested that individuals with normal blood pressure who later develop hypertension may be more likely to have underlying subclinical PA.He posited that many cases currently categorized as “primary” or “essential” hypertension might actually be driven by aldosterone-mediated mechanisms due to subclinical PA. He emphasized the need to move beyond a generalized approach to early hypertension management and adopt a more individualized strategy that addresses the specific biological drivers of hypertension and cardiovascular disease in each person.
Dr. Wenyu Huang, an associate professor at Northwestern University’s Feinberg School of Medicine, concurred that current practices might be overlooking a considerable number of at-risk individuals. She pointed out that while Endocrine Society guidelines now recommend screening all hypertensive patients for primary aldosteronism, this new study extends the concern to individuals with normal blood pressure. Although the study establishes an association rather than causation, Dr. Huang believes these findings warrant significant attention.
Both Dr. Hundemer and Dr. Huang reported no relevant financial conflicts of interest. Paul Basilio, a freelance writer and editor based in Glenside, Pennsylvania, contributed to this report.