Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Vasc Surg. 2018 Jul;68(1):128-135. doi: 10.1016/j.jvs.2017.05.117. Epub 2018 Mar 13.
The renin-angiotensin-aldosterone system is increasingly being recognized to play an important role in the development and clinical course of cardiovascular diseases. Renin-angiotensin-aldosterone system activation is associated with clinical outcome in various populations of cardiovascular patients, such as patients with coronary artery, peripheral artery, and cerebrovascular disease. In this study, we investigated the associations between plasma renin and aldosterone concentrations and atherosclerotic plaque characteristics and secondary vascular events in patients undergoing carotid endarterectomy.
Baseline plasma renin and aldosterone concentrations from 506 subjects undergoing carotid endarterectomy (mean age, 67 ± 9 years; 65% male) were correlated with histopathologic characteristics and inflammatory protein concentrations of the excised atherosclerotic plaque. Ordinal logistic regression (for ordinal outcome parameters) or linear regression (for linear outcome) analysis did not show a statistically significant relationship between plasma renin or aldosterone concentrations and plaque fat, thrombus, calcifications, collagen, smooth muscle cells, or macrophage content. Neither could any association be found with intraplaque inflammatory mediators. During a median follow-up of 3 years, 102 (20%) patients experienced a major secondary vascular event (composite of stroke, myocardial infarction, leg amputation, vascular death, or coronary revascularization or peripheral intervention). In multivariable Cox regression analysis, including both renin and aldosterone, baseline renin concentrations were associated with the occurrence of secondary events.
In patients with established atherosclerotic disease undergoing carotid endarterectomy, plasma renin and aldosterone concentrations were not associated with atherosclerotic plaque characteristics. Plasma renin concentration was positively associated with the occurrence of major secondary vascular events.
肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system）在心血管疾病的发生和临床过程中发挥着重要作用，这一观点正逐渐得到认可。肾素-血管紧张素-醛固酮系统的激活与各种心血管患者人群的临床预后相关，例如冠状动脉疾病、外周动脉疾病和脑血管疾病患者。在本研究中，我们调查了行颈动脉内膜切除术的患者的血浆肾素和醛固酮浓度与动脉粥样硬化斑块特征和二级血管事件之间的相关性。
对 506 例行颈动脉内膜切除术（平均年龄 67±9 岁；65%为男性）患者的基线血浆肾素和醛固酮浓度与切除的动脉粥样硬化斑块的组织病理学特征和炎症蛋白浓度进行了相关性分析。有序逻辑回归（用于有序结果参数）或线性回归（用于线性结果）分析未显示血浆肾素或醛固酮浓度与斑块脂肪、血栓、钙化、胶原、平滑肌细胞或巨噬细胞含量之间存在统计学显著关系。也未能发现与斑块内炎症介质之间存在任何关联。在中位 3 年的随访期间，102 名（20%）患者发生了主要的二级血管事件（中风、心肌梗死、腿部截肢、血管性死亡、或冠状动脉血运重建或外周介入治疗的复合事件）。在包括肾素和醛固酮的多变量 Cox 回归分析中，基线肾素浓度与二级事件的发生相关。
在接受颈动脉内膜切除术的已确诊动脉粥样硬化疾病患者中，血浆肾素和醛固酮浓度与动脉粥样硬化斑块特征无关。血浆肾素浓度与主要二级血管事件的发生呈正相关。
