Elevated Aldosterone-Renin Ratio Tied to Atrial Fibrillation and Stroke in Older Adults

A prospective US cohort study leveraging data from 3,477 participants (mean age 74.8 years; 61.5% female) in the Atherosclerosis Risk in Communities (ARIC) study has found that higher aldosterone-renin ratio (ARR) is independently associated with increased cardiovascular risk over nearly a decade of follow-up. Researchers measured serum aldosterone and renin levels at baseline (2011-2013) among adults free of heart failure, myocardial infarction, and stroke, excluding those on potassium-sparing diuretics. With median aldosterone levels at 5.1 ng/dL (conversion factor ×27.74 for pmol/L), renin activity at 0.78 ng/mL/h , and ARR at 5.9 ng/dL per ng/mL/h , the analysis employed Cox regression to assess associations with incident CVD. Over nine years, each doubling of ARR corresponded to a 4% higher risk for the composite outcome of heart failure hospitalization, atrial fibrillation, stroke, myocardial infarction, or death (aHR: 1.04). Specifically, ARR doubling was linked to a 13% increased risk of ischemic stroke (aHR: 1.13) and a 10% increased risk of atrial fibrillation (aHR: 1.10), though no significant associations emerged for heart failure hospitalization or myocardial infarction. These findings underscore that renin-independent aldosteronism exists across a broader spectrum than traditionally recognized and implicates the aldosterone pathway as a modifiable target for preventing atrial fibrillation and stroke in aging populations. Source: https://jamanetwork.com/journals/jamacardiology/