Researchers link aldosterone, plasma renin activity to increased risk for CVD in black Americans

Increased levels of aldosterone and plasma renin activity (PRA) are associated with greater risk of cardiovascular disease (CVD) and all-cause mortality among blacks in the U.S., according to a community-based study.

Each incremental, logarithmic increase in aldosterone was linked to a 13 percent increased risk of death and a 26 percent increased risk of incident CVD, defined as a composite of coronary heart disease, stroke and heart failure. Similarly, each log-PRA increase led to increases of 12 percent for all-cause mortality and 16 percent for CVD.

Adjustment for baseline factors was taken into account for these calculations, which were published online in JACC: Heart Failure.

“Our study reveals novel associations of aldosterone and PRA with incident CVD and all-cause mortality among community-dwelling African Americans,” wrote lead researcher Joshua J. Joseph, with the department of medicine at Ohio State University, and colleagues. “It suggests that the RAAS (renin-angiotensin-aldosterone system) should be considered in the identification of high-risk individuals, to optimize therapeutic or preventive strategies for CVD and mortality in African Americans through a more personalized approach.”

The RAAS plays an important role in the development in hypertension, the authors pointed out. By studying its components in relation to CVD and death, Joseph and colleagues sought to explain why previous research has shown African-Americans to have disproportionately high incidences of hypertension and heart failure.

Joseph and colleagues analyzed individuals enrolled in the Jackson Heart Study, a prospective cohort study of 5,401 black adults, from 21 to 94 years old, from metropolitan Jackson, Mississippi.

They identified 4,160 participants without prevalent CVD and followed them for an average of seven years to study the effects aldosterone and PRA had on the development of CVD. For the all-cause mortality analysis, the researchers followed 4,985 participants for an average of eight years.

Joseph et al. noted their analyses were limited to one area and may not be generalizable to other regions. Also, aldosterone and PRA levels were only measured at baseline, so changes weren’t accounted for during follow-up.

“Further research and clinical trials exploring the impact of current and novel RAAS antagonists in the prevention of CVD, over and above blood pressure and cardiac remodeling in African Americans (that is, stroke, glucose metabolism and so on) is paramount given the potential to improve cardiovascular health and reduce racial/ethnic disparities in CVD and mortality,” the researchers wrote.