Key result
Persistently elevated pACE2 (> 23 ng/mL) after targeted treatments in primary aldosteronism patients was associated with increased all-cause mortality and cardiovascular events (HR 8.8; P = .04).
Why the study?
Plasma concentrations of ACE2 are associated with cardiovascular disease, but whether higher levels occur in primary aldosteronism and lead to increased cardiovascular events was unclear.
Is persistently elevated pACE2 after targeted treatments associated with increased mortality and cardiovascular events in patients with primary aldosteronism?
Cohort (n=168)
Is persistently elevated pACE2 after targeted treatments associated with increased mortality and cardiovascular events in patients with primary aldosteronism?
Answers are grounded in this paper and cite their sources.
Persistently elevated plasma ACE2 levels after targeted treatment for primary aldosteronism serve as a strong biomarker for increased risk of mortality and cardiovascular events.
CONTEXT: The plasma concentrations of angiotensin-converting enzyme 2 (pACE2) has been independently associated with cardiovascular diseases. OBJECTIVE: Higher pACE2 concentrations may be found in patients with primary aldosteronism (PA) and might lead to increased cardiovascular events. METHODS: Using an inception observational cohort, we examined pACE2 among 168 incident patients with PA. The expression of ACE2, serine protease 2 (TMPRSS2), and metalloprotease 17 (ADAM17) were assessed in peripheral blood mononuclear cells. RESULTS: Incident PA and essential hypertension (EH) patients had similarly elevated pACE2 (47.04 ± 22.06 vs 46.73 ± 21.06 ng/mL; P = .937). Age was negatively (β = -2.15; P = .033) and higher serum potassium level (β = 2.29; P = .024) was positively correlated with higher pACE2 in PA patients. Clinical complete hypertension remission after adrenalectomy (Primary Aldosteronism Surgery Outcome criteria) was achieved in 36 (50%) of 72 surgically treated unilateral PA (uPA) patients. At follow-up, pACE2 decreased in surgically treated patients who had (P < .001) or had no (P = .006) hypertension remission, but the pACE2 attenuation was not statistically significant in uPA (P = .085) and bilateral PA (P = .409) administered with mineralocorticoid receptor antagonist (MRA). Persistently elevated pACE2 (> 23 ng/mL) after targeted treatments was related to all-cause mortality and cardiovascular events among PA patients (hazard ratio = 8.8; P = .04); with a mean follow-up of 3.29 years. TMPRSS2 messenger RNA (mRNA) expression was higher in uPA (P = .018) and EH (P = .038) patients than in normotensive controls; it was also decreased after adrenalectomy (P < .001). CONCLUSION: PA and EH patients had elevated pACE2 and higher expression of TMPRSS2 mRNA compared to those of normotensive population. Persistently elevated pACE2 (> 23 ng/mL) after targeted treatments was associated risk of mortality and incident cardiovascular events.
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Wu et al. (2022) conducted a cohort in Primary aldosteronism (n=168). Persistently elevated pACE2 (> 23 ng/mL) vs. Non-elevated pACE2 was evaluated on All-cause mortality and cardiovascular events (HR 8.8, p=.04). Persistently elevated pACE2 (> 23 ng/mL) after targeted treatments in primary aldosteronism patients was associated with increased all-cause mortality and cardiovascular events (HR 8.8; P = .04).
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