Higher Plasma Aldosterone Concentrations Are Associated With Elevated Risk of Aortic Dissection and Aneurysm: a Case-Control Study

Abstract

Background: Animal models demonstrate circulating aldosterone leads to aortic dissection and aneurysm, whereas data from humans are lacking. Therefore, we aimed to examine the associations of plasma aldosterone concentrations (PAC) with aortic dissection and aneurysm. Methods: We identified patients with aortic dissection and aneurysm with assessed PAC before disease onset from hospital-based electronic database and set as case group. Simultaneously, age and gender-matched cohort with PAC measurement whereas without aortic dissection and aneurysm were selected as control group using ratio of 1:4. Multi-variable logistic regression analysis was used to assess the relationship of PAC with aortic dissection and aneurysm. Results: Totally, 133 cases and 531 controls (all hypertensive) were enrolled between 2004 and 2021, with 77.9% men, mean age of 55.5 years and PAC of 13.9 ng/dL. Case group showed significantly higher PAC(14.51 versus 13.65 ng/dL, P =0.012) than did control group. In logistic regression analysis, higher PAC exhibited 1.68-fold higher odds (95% CI, 1.14–2.48, P =0.008) for presence of aortic dissection and aneurysm, significant in adjusted model (odds ratio, 1.69 [95% CI, 1.11–2.57], P =0.015). In stratified analysis, the association between the 2 was observed in women of all ages and in men with coronary artery disease. Sensitivity analysis by excluding those under interfering agents at PAC measurement and those with primary aldosteronism did not change the relationship of the 2. Conclusions: Higher PAC is associated with the increased odd for aortic dissection and aneurysm in patients with hypertension, even in the absence of primary aldosteronism, implying that PAC might be a target for prevention.

Association of objective and subjective parameters of obstructive sleep apnea with plasma aldosterone concentration in 2,066 hypertensive and 25,368 general population

“…Elevated circulating aldosterone has consistently been shown to be a risk factor for vascular disease ( 10 , 33 , 35 – 37 ) and renal dysfunction ( 32 ) in various population. It is undetermined whether circulating aldosterone is elevated in OSA, a well-known risk factor for CVD ( 3 , 4 ).…”

“…In clinical data, PRA was also measured by radioimmunoassay (RIA) using commercial kits (Center of Beifang Biology Technique, Beijing, China), and the intra- and inter-assay coefficients of variation were less than 10% and 15%, respectively. The details of the measurements are described in previous studies from our center ( 32 , 33 ).…”

Relationships between statins and risk reduction of aortic dissection in patients with hypertension

“…Statins improve atherosclerosis by decreasing the number of OxLDL-containing macrophages and increasing the content of smooth muscle cells and collagen in vessel wall [19,24,25]. Thus, statins protect blood vessels not only by lowering blood lipids, but also by promoting vascular remodeling and decreasing oxidative stress [25,26].…”

Aldosterone and Aortic Aneurysms: the Dissection of a Potential New Mechanism to Prevent Rupture

“…Therefore, increased understanding of the mechanisms involved in the pathophysiology of aortic aneurysms has the potential to broaden the scope of targeted medical therapies for prevention and management. The findings of Zhu et al 3 in this issue offer insight into an important association between aldosterone and the increased risk of aneurysmal disease.…”