Aldosterone, Renin, Cardiovascular Events, and All-Cause Mortality Among African Americans

Abstract

Background There is a paucity of data on the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD) or all-cause mortality (mortality) among community-dwelling African Americans (AAs). Objective We examined the association of aldosterone and PRA with incident CVD (composite endpoint of coronary heart disease (CHD), stroke and heart failure) and mortality among AAs in the Jackson Heart Study. Methods A total of 4,985 AA adults, aged 21–94 years, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (2000–2004). Incident events included CHD and stroke (assessed from 2000–2011) and heart failure (assessed from 2005–2011). Cox models were used to estimate hazard ratios (HR) for incident CVD and mortality adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake and body mass index. Results Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-unit standard deviation (SD) increase in log-aldosterone and log-PRA were associated with HRs of 1.26 (95% CI: 1.14, 1.40) and 1.16 (95% CI: 1.02, 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-unit SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04, 1.23) and 1.12 (95% CI: 1.01, 1.24) for mortality, respectively. Conclusions Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among AAs.

The Association of Life’s Simple 7 with Aldosterone among African Americans in the Jackson Heart Study

“…Based on the ratio, one can make a relative comparison in terms of percent change. Covariates were selected a priori with adjustment for age, sex, education, occupation, alcohol use, and eGFR based on prior analyses [2,5,6].…”

“…Diabetes was defined as A1c ≥ 6.5% (48 mmol/mol), fasting blood glucose ≥126 mg/dL, taking diabetes medications or a self-reported physician diagnosis. We performed sensitivity analyses excluding participants on medications that alter aldosterone including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and statin medications [6]. Aldosterone initially decreases with ACE-inhibitors and angiotensin receptor blockers but over time aldosterone levels increase to pretreatment levels or above, a phenomenon termed aldosterone breakthrough.…”

“…There is currently limited exploration of LS7 with biological hormones that contribute to adverse cardiometabolic outcomes. Higher aldosterone has been associated with higher incidence of metabolic syndrome, diabetes, CVD and all-cause mortality among African Americans (AA) and thus represents one such potential hormone [5,6,7]. Additionally, there is limited data on the association of the individual LS7 metrics with aldosterone among AAs.…”

Management and treatment of glomerular diseases (part 2): Conclusions From A Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference

“…Aldosterone blockade reduces cardiovascular mortality in patients with heart failure and also reduces albuminuria. [40][41][42] However, the absolute risk-benefit ratio for aldosterone blockade in GN remains unclear.…”

Causes for increased incidence of heart disease Among African American Community

“…Increased stress levels cause increased incidence of cardiovascular disease 9 . Stress can be influenced by financial issues, mental health, genetics, and elevated biochemistry levels 1,10,20 . These factors alone cause negative effects on health, but a combination of these factors causes dire consequences.…”