Optimizing the aldosterone-to-renin ratio cut-off for screening primary aldosteronism based on cardiovascular risk: a collaborative study

作者全名：He, Chunxue; Li, Ruolin; Yang, Jun; Shen, Hang; Wang, Yue; Chen, Xiangjun; Luo, Wenjin; Zeng, Qinglian; Ma, Linqiang; Song, Ying; Cheng, Qingfeng; Wang, Zhihong; Wu, Fei-Fei; Li, Qifu; Yang, Shumin; Hu, Jinbo

作者地址：[He, Chunxue; Shen, Hang; Wang, Yue; Chen, Xiangjun; Luo, Wenjin; Zeng, Qinglian; Ma, Linqiang; Song, Ying; Cheng, Qingfeng; Wang, Zhihong; Li, Qifu; Yang, Shumin; Hu, Jinbo] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrinol, 1 Youyi St, Chongqing 400016, Peoples R China; [Li, Ruolin] Chongqing Med Univ, Affiliated Hosp 1, Dept Dermatol, Chongqing, Peoples R China; [Yang, Jun] Hudson Inst Med Res, Ctr Endocrinol & Metab, Clayton, Vic, Australia; [Yang, Jun] Monash Univ, Dept Med, Clayton, Vic, Australia; [Wu, Fei-Fei] Changzhi Med Coll, Affiliated Heping Hosp, Dept Endocrinol, Changzhi, Peoples R China

通信作者：Li, QF; Yang, SM; Hu, JB (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrinol, 1 Youyi St, Chongqing 400016, Peoples R China.

来源：CLINICAL AND EXPERIMENTAL HYPERTENSION

ESI学科分类：PHARMACOLOGY & TOXICOLOGY

WOS号：WOS:001224333400001

JCR分区：Q3

影响因子：1.5

年份：2024

卷号：46

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Aldosterone-to-renin ratio; cardiovascular risk; cutoff; primary aldsoteronism; screening

摘要：Objectives: Aldosterone-to-renin ratio (ARR) based screening is the first step in the diagnosis of primary aldosteronism (PA). However, the guideline-recommended ARR cutoff covers a wide range, from the equivalent of 1.3 to 4.9 ng center dot dl(-1)/mIU center dot l(-1). We aimed to optimize the ARR cutoff for PA screening based on the risk of cardiovascular diseases (CVD). Methods: Longitudinally, we included hypertensive participants from the Framingham Offspring Study (FOS) who attended the sixth examination cycle and followed up until 2014. At baseline (1995-1998), we used circulating concentrations of aldosterone and renin to calculate ARR (unit: ng center dot dl(-1)/mIU center dot l(-1)) among 1,433 subjects who were free of CVD. We used spline regression to calculate the ARR threshold based on the incident CVD. We used cross-sectional data from the Chongqing Primary Aldosteronism Study (CONPASS) to explore whether the ARR cutoff selected from FOS is applicable to PA screening. Results: In FOS, CVD risk increased with an increasing ARR until a peak of ARR 1.0, followed by a plateau in CVD risk (hazard ratio 1.49, 95%CI 1.19-1.86). In CONPASS, when compared to essential hypertension with ARR < 1.0, PA with ARR >= 1.0 carried a higher CVD risk (odds ratio 2.24, 95%CI 1.41-3.55), while essential hypertension with ARR >= 1.0 had an unchanged CVD risk (1.02, 0.62-1.68). Setting ARR cutoff at 2.4 similar to 4.9, 10% similar to 30% of PA subjects would be unrecognized although they carried a 2.45 similar to 2.58-fold higher CVD risk than essential hypertension. Conclusions: The CVD risk-based optimal ARR cutoff is 1.0 ng center dot dl(-1)/mIU center dot l(-1) for PA screening. The current guideline-recommended ARR cutoff may miss patients with PA and high CVD risk. Clinical Trial Registration: ClinicalTrials.gov (NCT03224312)

基金机构：National Natural Science Foundation of China [U21A20355, 82170825, 82100833, 2022YFC2505300, 2022YFC2505301, 2022YFC2505302, 2022YFC2505306]; National key research & development plan of China [82270878, 81870567, 81970720, 82000810, 2021YFC2501600, 2021YFC2501603]; Joint Medical Research Project of Chongqing Science and Technology Commission & Chongqing Health and Family Planning Commission [2022ZDXM003]; Chongqing Outstanding Youth Funds [cstc2019jcyjjq0006]; China Postdoctoral Science Foundation [2019M663499, 2020T130760, 2021MD703927]; Program for Youth Innovation in Future Medicine, Chongqing Medical University; Natural Science Foundation of Chongqing, China [cstc2020jcyj-bshX0081, cstc2021jcyj-bshX0207]; Intelligent Medicine Research Project of Chongqing Medical University [ZHYX202113]

基金资助正文：This work was supported by National Natural Science Foundation of China, Major Joint Project (U21A20355); National key research & development plan of China, major project of prevention and treatment for common diseases (2022YFC2505300, sub-project: 2022YFC2505301, 2022YFC2505302, 2022YFC2505306); National Natural Science Foundation of China (82270878, 81870567, 81970720, 82000810, 82170825, 82100833); National key research & development plan of China, major project of prevention and treatment for common diseases (2021YFC2501600, sub-project: 2021YFC2501603); Joint Medical Research Project of Chongqing Science and Technology Commission & Chongqing Health and Family Planning Commission (Major Project, 2022ZDXM003); Chongqing Outstanding Youth Funds (cstc2019jcyjjq0006); The China Postdoctoral Science Foundation (2019M663499, 2020T130760, 2021MD703927) ;Program for Youth Innovation in Future Medicine, Chongqing Medical University. The Natural Science Foundation of Chongqing, China (cstc2020jcyj-bshX0081, cstc2021jcyj-bshX0207); Intelligent Medicine Research Project of Chongqing Medical University (NO: ZHYX202113).