BACKGROUND Primary aldosteronism, characterized by renin-independent aldosterone production, is associated with adverse cardiovascular remodeling and outcomes. Elevated cardiovascular risk is observed even in subclinical forms of primary aldosteronism according to studies conducted primarily in middle-aged and elderly populations. This study aimed to assess whether early changes in primary aldosteronism biomarkers during young adulthood are associated with arterial stiffness and left ventricular mass index (LVMI) before the onset of overt disease. METHODS The Raine Study is a longitudinal, population-based cohort study in Western Australia that enrolled women during pregnancy. We analyzed the data from the offspring of these women at 17 (2006-2009) and 27 (2016-2018) years of age. Participants with elevated high-sensitivity C-reactive protein (>10 mg/L) and female participants who were on oral contraception were excluded. Pulse wave velocity and aortic augmentation index were measured by SphygmoCor Pulse Wave System at both ages, and aortic distensibility and LVMI were measured by cardiac magnetic resonance imaging at 27 years. Multivariable linear regression was used to examine the relationship between plasma renin, aldosterone, or aldosterone-to-renin ratio and arterial stiffness and LVMI. Mediation analysis was used to test the role of systolic blood pressure. RESULTS This study included 859 participants at 17 (38.0% female) and 758 participants at 27 (33.2% female) years of age. Females had lower renin concentration at both 17 (20.7 mU/L versus 25.7 mU/L; P<0.001) and 27 (12.0 mU/L versus 15.4 mU/L; P<0.001) years of age; hence, the aldosterone-to-renin ratio was significantly higher at both 17 (18.2 versus 13.5; P<0.001) and 27 (21.0 versus 15.6; P<0.001) years of age in females compared with males. At 27 years of age, a significant association was detected between aldosterone and LVMI in males (β=0.009 [95% CI, 0.001-0.017]; P=0.027) and between aldosterone-to-renin ratio and LVMI in females (β=0.098 [95% CI, 0.001-0.196]; P=0.050) independently of systolic blood pressure and other confounders. No association was found between primary aldosteronism biomarkers and measures of arterial stiffness (pulse wave velocity, aortic augmentation index, and aortic distensibility) at either age. CONCLUSIONS Aldosterone concentration and aldosterone-to-renin ratio were positively associated with the LVMI in young males and females, respectively, independently of systolic blood pressure. Long-term follow-up is required to determine whether the relationship persists over time, and clinical trials are needed to assess the cardiovascular benefits of early interventions to block aldosterone.

中文翻译：

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年轻人肾素、醛固酮、醛固酮与肾素比值与动脉硬度和左心室质量指数之间的关系。


背景 原发性醛固酮增多症，以肾素非依赖性醛固酮产生为特征，与不良心血管重塑和结局相关。根据主要在中老年人群中进行的研究，即使在亚临床形式的原发性醛固酮增多症中也观察到心血管风险升高。本研究旨在评估青年期原发性醛固酮增多症生物标志物的早期变化是否与显性疾病发作前的动脉僵化和左心室质量指数 （LVMI） 相关。方法 Raine 研究是西澳大利亚州的一项基于人群的纵向队列研究，招募了怀孕期间的妇女。我们分析了这些女性在 17 岁 （2006-2009） 和 27 岁 （2016-2018） 岁时后代的数据。高敏 C 反应蛋白升高 （>10 mg/L） 的参与者和口服避孕药的女性参与者被排除在外。两个年龄段均采用 SphygmoCor 脉搏波系统测量脉搏波速度和主动脉增强指数，27 岁时采用心脏磁共振成像测量主动脉扩张性和 LVMI。采用多变量线性回归检查血浆肾素、醛固酮或醛固酮与肾素比值与动脉硬度和 LVMI 之间的关系。中介分析用于测试收缩压的作用。结果这项研究包括 859 名 17 岁的参与者 （38.0% 为女性） 和 758 名 27 岁的参与者 （33.2% 为女性）。女性在 17 时肾素浓度较低（20.7 mU/L 对 25.7 mU/L;P<0.001）和 27 （12.0 mU/L 对 15.4 mU/L;P<0.001） 岁;因此，醛固酮与肾素的比值在 17 时均显著升高（18.2 对 13.5;P<0.001） 和 27 （21.0 对 15.6;P<0 的。001） 岁 女性 与 男性 相比。在 27 岁时，在男性中检测到醛固酮和 LVMI 之间存在显着关联 （β=0.009 [95% CI，0.001-0.017];P = 0.027）和女性醛固酮与肾素比值与 LVMI 之间的 （β=0.098 [95% CI，0.001-0.196];P=0.050） 独立于收缩压和其他混杂因素。在两个年龄段，原发性醛固酮增多症生物标志物与动脉硬度测量 （脉搏波速度、主动脉增强指数和主动脉扩张性） 之间均未发现关联。结论醛固酮浓度和醛固酮与肾素比值分别与年轻男性和女性的 LVMI 呈正相关，与收缩压无关。需要长期随访以确定这种关系是否随着时间的推移而持续存在，并且需要临床试验来评估早期干预阻断醛固酮的心血管益处。