Plasma Renin Activity Predicts Cardiovascular Mortality in the Heart Outcomes Prevention Evaluation (HOPE) Study
What is the association of baseline plasma renin activity (PRA) concentrations with cardiovascular (CV) events and mortality in patients with stable vascular disease and/or diabetes?
The investigators 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 2,913 patients enrolled in the Heart Outcomes Prevention Evaluation (HOPE) study. Subjects were followed for a median of 4.5 years. Age- and sex-adjusted and fully multivariable-adjusted hazard ratios (HRs) were estimated.
Compared with the referent lowest fifth, subjects in the highest fifth of the PRA distribution had an 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.
The authors concluded that 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.
The major finding of this study is that PRA was a predictor of major vascular events in a large cohort of patients with stable atherosclerotic vascular disease and/or diabetes. Individuals in the top PRA quintile had a nearly two-fold increased risk of CV death, and the strength of these associations was independent of clinical characteristics, background use of beta-blockers and diuretics, treatment allocation to ramipril, and inflammatory biomarkers. PRA may identify a population of patients at risk of increased mortality, in part via either transition to heart failure or sudden cardiac death, and may represent a potential target for therapy in high-risk patients with atherosclerosis and/or diabetes.
Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias, Lipid Metabolism, Novel Agents, Acute Heart Failure, Heart Failure and Cardiac Biomarkers
Keywords: Atherosclerosis, Biological Markers, Renin, Heart Failure, Risk Factors, Population Dynamics, Death, Sudden, Cardiac, Diabetes Mellitus
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