Compared with the lowest quartile, the highest quartile of plasma renin concentration was associated with an increased risk of cardiovascular mortality (HR 1.79; 95% CI 1.28-2.48).
Cohort (n=3,303)
Does higher plasma renin concentration associate with increased cardiovascular mortality in patients referred to coronary angiography?
Elevated plasma renin concentration is independently associated with increased long-term cardiovascular mortality, sudden cardiac death, and heart failure death in patients referred for coronary angiography.
Effect estimate: HR 1.79 (95% CI 1.28-2.48)
AIMS: Renin is the key regulator of the renin-angiotensin-aldosterone system. Previous studies have reported conflicting results on the relation of plasma renin with fatal cardiovascular events. This study in a large cohort of patients sought to evaluate the association between plasma renin concentration (PRC) and cardiovascular mortality after long-term follow-up of almost 10 years. METHODS AND RESULTS: Plasma renin concentration median: 11.4 (6.0-24.6) pg/mL was measured in 3303 patients (mean age: 62.7 ± 10.6 years; 30.3% women) referred to coronary angiography. After a median follow-up of 9.9 years, 554 participants (16.8%) with PRC measurement at baseline had died due to fatal cardiovascular events. Multivariable-adjusted Cox analysis revealed that when compared with participants in the lowest PRC quartile, those in the highest quartile were at increased risk of cardiovascular mortality (hazard ratio: 1.79, 95% CI 1.28-2.48). Analyses of specific causes of cardiovascular death showed that for each standard deviation increase in log-PRC there was a 22% (P = 0.006) increase in risk of sudden cardiac death and a 23% (P = 0.033) greater risk of death due to heart failure. The association of PRC with cardiovascular mortality remained stable after adjustment for established cardiovascular risk factors, ongoing antihypertensive medication, immunoreactive angiotensin II, and aldosterone levels. Age, N-terminal pro-B-type natriuretic peptide levels, coronary artery disease, the use of angiotensin-converting enzyme-inhibitors, beta-blockers, diuretics, and kidney function were important effect modifiers. CONCLUSIONS: Plasma renin concentration is associated with long-term cardiovascular mortality in patients referred to coronary angiography. Further intervention studies should determine whether renin is a potential therapeutic target or only a marker of mortality risk in various cardiovascular risk groups.
Tomaschitz et al. (Mon,) ont mené une cohorte chez des patients référés pour une angiographie coronaire (n=3 303). La concentration de rénine plasmatique par rapport au quartile le plus bas de PRC a été évaluée sur la mortalité cardiovasculaire (HR 1,79, IC à 95 % 1,28-2,48). Comparé au quartile le plus bas, le quartile le plus élevé de la concentration de rénine plasmatique était associé à un risque accru de mortalité cardiovasculaire (HR 1,79 ; IC à 95 % 1,28-2,48).
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