Association of cardiovascular disease risk and changes in renin levels by mineralocorticoid receptor antagonists in patients with primary aldosteronism
Association of cardiovascular disease risk and changes in renin levels by mineralocorticoid receptor antagonists in patients with primary aldosteronism
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DOI：
10.1038/s41440-022-00960-x
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发表时间：
2022-06-28
影响因子：
5.4
通讯作者：
Naruse, Mitsuhide
中科院分区：
文献类型：
--
作者：
Nomura, Motoko;Kurihara, Isao;Naruse, Mitsuhide
最近的一份报告指出，在盐皮质激素受体拮抗剂治疗期间肾素仍然受到抑制的原发性醛固酮增多症患者比肾素活性未受抑制的患者发生心血管疾病的风险更高。我们回顾调查了1115名接受盐皮质激素受体拮抗剂治疗的日本原发性醛固酮增多症患者的复合心血管疾病的发生率和心血管疾病的危险因素。中位随访期为3.0年，5年随访期间心血管事件发生率非常低(2.1%)。盐皮质激素受体拮抗剂治疗前后血浆肾素活性变化按血浆肾素活性变化分为三组，心血管事件发生率分别为2.1%、0.5%和3.7%。多因素Cox回归分析显示，年龄(调整后的危险比，1.07；95%可信区间，[1.02-1.12])和体重指数(调整后的危险比，1.13[1.04-1.23])是心血管疾病的独立危险因素。使用盐皮质激素受体拮抗剂治疗的高血浆肾素活性改变组的心血管疾病风险显著高于中等血浆肾素活性改变组(调整风险比，5.71[1.28-25.5])。这些数据表明，盐皮质激素受体拮抗剂治疗后肾素水平的高变化不一定预示着原发性醛固酮增多症患者心血管疾病的更好预后。
A recent report stated that patients with primary aldosteronism who remain renin suppressed during mineralocorticoid receptor antagonist treatment might have a higher risk of developing cardiovascular disease than those with unsuppressed renin activity. We retrospectively investigated the incidence of composite cardiovascular disease and risk factors for cardiovascular disease in 1115 Japanese patients with primary aldosteronism treated with mineralocorticoid receptor antagonists. The median follow-up period was 3.0 years, and the incidence of cardiovascular events was very low (2.1%) throughout 5 years of follow-up. Changes in plasma renin activity from before to after mineralocorticoid receptor antagonist treatment were divided into three groups based on tertile, low, intermediate, and high plasma renin activity change groups, with incidences of cardiovascular disease events of 2.1%, 0.5%, and 3.7%, respectively. Multivariate Cox regression analysis revealed age (adjusted hazard ratio, 1.07; 95% confidence interval, [1.02-1.12]) and body mass index (adjusted hazard ratio, 1.13 [1.04-1.23]) as independent risk factors for cardiovascular disease. The high plasma renin activity change group had significantly higher cardiovascular disease risk with mineralocorticoid receptor antagonist treatment than the intermediate plasma renin activity change group (adjusted hazard ratio, 5.71 [1.28-25.5]). These data suggest that a high change in renin level after mineralocorticoid receptor antagonist treatment may not necessarily predict a better prognosis of cardiovascular disease in patients with primary aldosteronism.