A spectrum of primary aldosteronism, indicated by a higher aldosterone-renin ratio (ARR), may contribute to an increased risk of atrial fibrillation (AF) and ischaemic stroke in older adults, according to a new cohort study analysis.¹
Methodology
This prospective cohort analysis used data from the Atherosclerosis Risk in Communities (ARIC) study. The investigation included 3,477 community-dwelling participants who had serum aldosterone and renin levels measured between 2011 and 2013. The cohort had a mean age of 74.8 years, and 61.5% were female.
All participants were free of heart failure (HF), myocardial infarction (MI), stroke, and were not using potassium-sparing diuretics at the start of the analysis period. The study assessed the association between aldosterone parameters (serum aldosterone level and ARR) and incident cardiovascular disease (CVD) events over a nine-year follow-up.
The main outcomes measured were incident HF hospitalisation, AF, ischaemic stroke, MI, and a composite of these events plus all-cause death.
Results
Over the nine-year follow-up, a higher ARR was independently associated with the composite outcome (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.01–1.08 per doubling). Specifically, a higher ARR was linked to an increased risk of incident ischaemic stroke (aHR, 1.13; 95% CI, 1.02–1.26) and AF (aHR, 1.10; 95% CI, 1.05–1.15).
No significant association was found between higher ARR and incident HF hospitalisation (aHR, 1.02; 95% CI, 0.96–1.07) or MI (aHR, 1.01; 95% CI, 0.92–1.12).
Interpretation
The study authors concluded that the findings “underscore a spectrum of primary aldosteronism, in which higher ARR was independently associated with increased risks of AF and ischemic stroke among older adults, supporting the aldosterone pathway as a potential target for CVD prevention.” The results suggest that renin-independent aldosteronism, which is often underrecognised, may be a key factor in the development of specific cardiovascular events in the elderly population.
This study was funded by the National Heart, Lung, and Blood Institute.
References
1. Lassen MCH, Ostrominski JW, Claggett BL, et al. Spectrum of Primary Aldosteronism and Risk of Cardiovascular Outcomes: The Atherosclerosis Risk in Communities Study. JAMA Cardiol. Published online March 04, 2026. https://doi.org/10.1001/jamacardio.2026.0068
Disclaimer
The information presented in this article is for educational purposes only. Any quotes included reflect the opinions of the individual quoted, and do not necessarily reflect the views of the publisher. The publisher does not guarantee the accuracy or completeness of the content and accepts no responsibility for any errors, or any consequences arising from its use.