Plasma Renin Activity Predicts Cardiovascular Mortality in the Heart Outcomes Prevention Evaluation (HOPE) Study

Study Questions:

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?

Methods:

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.

Results:

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.

Conclusions:

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.

Perspective:

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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