Department of Cardiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, Groningen 9713GZ, The Netherlands.
Eur Heart J. 2012 Sep;33(18):2351-9. doi: 10.1093/eurheartj/ehs198. Epub 2012 Jul 17.
The renin-angiotensin system plays a central role in patients with established cardiovascular (CV) disease, but the prognostic effect of plasma renin in the community is unclear.
The relationship between plasma renin concentration and CV events was studied in 6228 subjects who were enrolled in the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) study, and who were not using antihypertensive medication. Plasma renin concentration was measured using a direct automated immunochemiluminescent assay. The mean (± SD) age was 47(± 12) years, 49% were male; the mean follow-up was 10.5 years. The median (Q1-Q3) plasma renin was 17.6 (10.9-27.2) µIU/mL, and plasma aldosterone was 119 (93-153) ng/L. The primary outcome was a composite of fatal (n = 27) and non-fatal (n = 408) CV events. Adjusted for age and sex each doubling of plasma renin was associated with a hazard ratio (HR) for the primary outcome of 1.22 (95% CI: 1.04-1.43; P= 0.015). In a multivariable model, plasma renin showed a positive correlation with heart rate and male sex and a negative correlation with blood pressure, urinary sodium, glucose, and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (adjusted R(2): 0.167, P< 0.001). After adjustment for covariates associated with plasma renin, the HR for reaching the primary outcome was 1.28 (95% CI: 1.09-1.49, P= 0.002). Plasma renin was associated with CV events regardless of blood pressure, but in subjects using antihypertensive medication this association was absent.
Plasma renin concentration is associated with an increased risk for CV events in a community-based cohort not on antihypertensive medication.
肾素-血管紧张素系统在已患有心血管（CV）疾病的患者中起着核心作用，但血浆肾素在社区中的预后作用尚不清楚。
在未使用抗高血压药物的 6228 名参加预防肾脏和血管终末期疾病（PREVEND）研究的受试者中，研究了血浆肾素浓度与 CV 事件之间的关系。使用直接自动化免疫化学发光测定法测量血浆肾素浓度。平均（±SD）年龄为 47（±12）岁，49%为男性；平均随访时间为 10.5 年。中位数（Q1-Q3）血浆肾素为 17.6（10.9-27.2）µIU/ml，血浆醛固酮为 119（93-153）ng/L。主要结局是致命（n=27）和非致命（n=408）CV 事件的复合结局。调整年龄和性别后，血浆肾素每增加一倍，主要结局的风险比（HR）为 1.22（95%CI：1.04-1.43；P=0.015）。在多变量模型中，血浆肾素与心率和男性呈正相关，与血压、尿钠、血糖和 N-末端 pro-B 型利钠肽（NT-pro-BNP）呈负相关（调整后的 R²：0.167，P<0.001）。在调整与血浆肾素相关的协变量后，达到主要结局的 HR 为 1.28（95%CI：1.09-1.49，P=0.002）。血浆肾素与 CV 事件相关，与血压无关，但在使用抗高血压药物的患者中，这种相关性不存在。
在未使用抗高血压药物的社区人群中，血浆肾素浓度与 CV 事件风险增加相关。
