Renin-independent aldosteronism is a common and often underrecognised condition. A new analysis from the Atherosclerosis Risk in Communities (ARIC) study has investigated whether this broader spectrum of aldosteronism is associated with incident cardiovascular disease (CVD) in older, community-dwelling adults.¹

Methodology

This prospective cohort analysis included 3,477 participants from the ARIC study. At baseline (2011–2013), participants had a mean age of 74.8 years, and 61.5% were female. All were free of heart failure (HF), myocardial infarction (MI), stroke, and were not using potassium-sparing diuretics. The study measured serum aldosterone levels and the aldosterone-renin ratio (ARR) as exposures. The main outcomes were incident HF hospitalisation, atrial fibrillation (AF), ischaemic stroke, MI, and a composite of these events plus all-cause death over a 9-year follow-up period.

Results

Over the 9-year follow-up, a higher ARR was independently associated with an increased risk for the composite outcome (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.01–1.08 per doubling). Specifically, a higher ARR was linked to a greater 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). However, the analysis found no significant association 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 highlights a spectrum of primary aldosteronism that may contribute to cardiovascular risk in older adults, even outside of a formal diagnosis. The 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.”¹ These results suggest that the aldosterone pathway could be a valuable target for cardiovascular prevention strategies, particularly for reducing the burden of AF and stroke in this population.

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 4, 2026. https://doi.org/10.1001/jamacardio.2026.0068

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