Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California; Department of Surgery and Abdelmalek, Department of Medicine at the VA, Veterans' Affairs Hospital, San Diego, California.
Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California; Department of Surgery and Abdelmalek, Department of Medicine at the VA, Veterans' Affairs Hospital, San Diego, California.
Am J Cardiol. 2020 Jun 15;125(12):1794-1800. doi: 10.1016/j.amjcard.2020.03.022. Epub 2020 Apr 2.
Experimental studies support a link between activation of the renin-angiotensin-aldosterone system and cardiovascular disease (CVD). The relationship with subclinical atherosclerosis is uncertain. Among 1,699 individuals without prevalent CVD from the Multiethnic Study of Atherosclerosis, we measured plasma renin activity (PRA) and aldosterone. Using multivariable logistic regression with restricted cubic splines, we assessed continuous log-transformed PRA and aldosterone associations with the ankle-brachial index (ABI) and coronary artery calcium (CAC) scores (Agatston) with adjustment for cardiovascular disease (CVD) risk factors, kidney function, and inflammatory biomarkers. In fully adjusted models mutually adjusting for PRA and aldosterone, higher PRA was associated with an ABI <1.0 (p overall <0.001, p nonlinear = 0.02) and CAC Agatston score >300 (p overall = 0.02, p nonlinear = 0.22), while aldosterone was not associated with either outcome. For example, compared to the 10th percentile (0.16 ng/ml/hr) of PRA, the 90th percentile (2.68 ng/ml/hr) had 3.6 times (OR 3.62; 95% CI: 2.13 to 6.13) and 1.7 times higher odds (odds ratio 1.67; 95% confidence interval: 1.13 to 2.48) of ABI <1.0 and CAC >300, respectively. These associations persisted after adjustment for levels of C-reactive protein, Interleukin-6, and Tumor Necrosis Factor-alpha. There were no significant differences in these associations by race/ethnicity or antihypertensive medication status. In conclusion, in a multiethnic cohort of community-living adults without prevalent clinical CVD, PRA was associated with greater burden of subclinical peripheral artery and coronary artery disease. These findings provide additional evidence that PRA may have deleterious effects on cardiovascular health through an atherosclerotic pathway.
实验研究支持肾素-血管紧张素-醛固酮系统的激活与心血管疾病（CVD）之间存在关联。但其与亚临床动脉粥样硬化的关系尚不确定。在无明显 CVD 的 1699 名多民族动脉粥样硬化研究参与者中，我们测量了血浆肾素活性（PRA）和醛固酮。采用多变量逻辑回归和受限立方样条，我们评估了连续对数转换的 PRA 与踝臂指数（ABI）和冠状动脉钙（CAC）评分（Agatston）之间的关系，同时调整了心血管疾病（CVD）风险因素、肾功能和炎症生物标志物。在完全调整的模型中，同时调整 PRA 和醛固酮，较高的 PRA 与 ABI<1.0（整体 p<0.001，p 非线性=0.02）和 CAC Agatston 评分>300（整体 p=0.02，p 非线性=0.22）相关，而醛固酮与这两个结果均无关。例如，与 PRA 的第 10 百分位数（0.16ng/ml/hr）相比，第 90 百分位数（2.68ng/ml/hr）的 ABI<1.0 和 CAC>300 的比值比（OR）分别为 3.6 倍（3.62；95%CI：2.13 至 6.13）和 1.7 倍（1.67；95%CI：1.13 至 2.48）。这些关联在调整 C 反应蛋白、白细胞介素 6 和肿瘤坏死因子-α水平后仍然存在。这些关联在种族/民族或抗高血压药物状态方面没有显著差异。总之，在一个没有明显临床 CVD 的多民族社区居住成年人队列中，PRA 与亚临床外周动脉和冠状动脉疾病的负担增加相关。这些发现提供了额外的证据，表明 PRA 可能通过动脉粥样硬化途径对心血管健康产生有害影响。
