Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study
Plasma renin activity predicts cardiovascular mortality in the Heart Outcomes Prevention Evaluation (HOPE) study
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DOI：
10.1093/eurheartj/ehr066
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发表时间：
2011-09-01
影响因子：
39.3
通讯作者：
Lonn, Eva M.
中科院分区：
文献类型：
--
作者：
Verma, Subodh;Gupta, Milan;Lonn, Eva M.
血浆肾素活性（PRA）已被提议作为心血管（CV）风险的独立预测因子，但来自大型前瞻性研究的数据有限，特别是在患有稳定性血管疾病和/或糖尿病的患者中，方法和结果：我们评估了PRA作为一个标志物在大量稳定的慢性血管疾病和/或心血管疾病患者中CV事件和死亡率的预测价值。或糖尿病和一个CV风险因素。基线PRA是在2913名参加心脏结局预防评价（HOPE）研究的患者中测量的。受试者的中位随访时间为4.5年。与参考最低五分之一相比，PRA分布最高五分之一的受试者主要血管事件复合终点的风险比（HR）为1.38（95%置信区间，1.03-1.86; P = 0.03），CV死亡的HR为1.89。这些协会仍然有统计学意义的充分调整后的临床特征，背景使用β受体阻滞剂，利尿剂，分配到ramietine，除了炎症生物标志物，高敏C反应蛋白，和N-末端脑钠肽前体。结论高PRA是一个独立的预测主要血管事件和死亡率在一个稳定的人群中的高风险动脉粥样硬化和/或糖尿病患者。虽然PRA的增加可能是更强烈的抗高血压治疗的标志物，但我们的研究结果表明，PRA可能是动脉粥样硬化和/或糖尿病高危患者的风险标志物和潜在治疗靶点。
Aims Plasma renin activity (PRA) has been proposed as an independent predictor of cardiovascular (CV) risk, but there are limited data from large prospective studies, particularly in patients with stable vascular disease and/or diabetes, without heart failure.Methods and results We evaluated the predictive value of PRA as a marker of CV events and mortality in a large population of patients with stable chronic vascular disease and/or diabetes and one CV risk factor. Baseline PRA was measured in 2913 patients enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study. Subjects were followed for a median of 4.5 years. Compared with the referent lowest fifth, subjects in the highest fifth of the PRA distribution had a hazard ratio (HR) of 1.38 (95% confidence interval, 1.03-1.86; P = 0.03) for the composite of major vascular events, with an HR of 1.89 for CV death. These associations remained statistically significant after full adjustment for clinical characteristics, background use of beta-blockers, diuretics, allocation to ramipril, in addition to inflammatory biomarkers, high-sensitivity C-reactive protein, and N-terminal pro-brain natriuretic peptide.Conclusion High PRA is an independent predictor of major vascular events and mortality in a stable population of high-risk patients with atherosclerosis and/or diabetes. Although an increase in PRA could be a marker of more intense antihypertensive therapy, our results suggest that PRA may represent a risk marker and potential target for therapy in high-risk patients with atherosclerosis and/or diabetes.