Author + information
- Received April 7, 2017
- Revision received May 18, 2017
- Accepted May 24, 2017
- Published online August 28, 2017.
- Joshua J. Joseph, MDa,b,∗ (, )
- Justin B. Echouffo-Tcheugui, MD, PhDc,
- Rita R. Kalyani, MD, MHSb,
- Hsin-Chieh Yeh, PhDb,
- Alain G. Bertoni, MD, MPHd,
- Valery S. Effoe, MD, MSd,
- Ramon Casanova, PhDd,
- Mario Sims, PhD, MSe,
- Wen-Chih Wu, MDf,
- Gary S. Wand, MDb,
- Adolfo Correa, MD, PhDe and
- Sherita H. Golden, MD, MHSb
- aDepartment of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
- bDivision of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
- cDivision of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Bostons, Massachusetts
- dDivision of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- eDepartment of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- fDepartment of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- ↵∗Address for correspondence:
Dr. Joshua J. Joseph, Department of Medicine, Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, Ohio 43210.
Objectives This study examined the association of aldosterone and plasma renin activity (PRA) with incident cardiovascular disease (CVD), using a composite endpoint of coronary heart disease, stroke, and/or heart failure and mortality among African Americans in the Jackson Heart Study.
Background There is a paucity of data for the association of aldosterone and PRA with incident CVD or all-cause mortality among community-dwelling African Americans.
Methods A total of 4,985 African American adults, 21 to 94 years of age, were followed for 12 years. Aldosterone, PRA, and cardiovascular risk factors were collected at baseline (from 2000 to 2004). Incident events included coronary heart disease and stroke (assessed from 2000 to 2011) and heart failure (assessed from 2005 to 2011). Cox models were used to estimate hazard ratios (HRs) for incident CVD and mortality, adjusting for age, sex, education, occupation, current smoking, physical activity, dietary intake, and body mass index.
Results Among 4,160 participants without prevalent CVD over a median follow-up of 7 years, there were 322 incident CVD cases. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HR of 1.26 (95% confidence intervals [CI]: 1.14 to 1.40) and 1.16 (95% CI: 1.02 to 1.33) for incident CVD, respectively. Over a median of 8 years, 513 deaths occurred among 4,985 participants. In adjusted analyses, each 1-U SD increase in log-aldosterone and log-PRA were associated with HRs of 1.13 (95% CI: 1.04 to 1.23) and 1.12 (95% CI: 1.01 to 1.24) for mortality, respectively.
Conclusions Elevated aldosterone and PRA may play a significant role in the development of CVD and all-cause mortality among African Americans.
The Jackson Heart Study was supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, and HHSN268201300050C from the National Heart, Lung, and Blood Institute and National Institute on Minority Health and Health Disparities. Dr. Joseph was supported by institutional training grant (T32 DK062707) from the National Institute of Diabetes and Digestive and Kidney Diseases. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 7, 2017.
- Revision received May 18, 2017.
- Accepted May 24, 2017.
- 2017 American College of Cardiology Foundation