Abstract 1133: Association Between Baseline Plasma Renin Activity and Risk of Cardiovascular Events in Women With Coronary Artery Disease
More women than men in the United States die from coronary artery disease (CAD) each year. The predictive ability of plasma renin activity (PRA), a marker of renin-angiotensin-aldosterone system activation, for future clinical events in women with CAD is not known. We analyzed the association between baseline PRA and clinical events in 437 women with CAD (≥50% stenosis by angiography; total n=1467) enrolled in the Intermountain Heart Collaborative Study cardiac catheterization registry; exclusion criteria were CHF (history, or ejection fraction <45%), history of myocardial infarction (MI), and current beta-blocker therapy. PRA measured from baseline plasma samples was evaluated as recursive partitioning categories (≤0.5, 0.51–2.3, >2.3 ng/mL/h) or tertiles (≤0.4, 0.41–1.90, ≥1.90 ng/mL/h). Maximum follow-up was 14.6 years (mean±SD, 6.4±3.2 years) for pre-defined outcomes all-cause death, fatal/nonfatal MI, CHF hospitalization, and cardiac morbidity/mortality (MI, CHF or cardiac death). Cox regression was performed adjusting for baseline characteristics. Mean age was 66.4 years, 70.0% of the women were hypertensive, and 29.5% had diabetes. By 5 years, a total of 73 had died, 24 experienced MI and 16 were hospitalized with CHF. Elevated PRA (category 3 vs 1; >2.3 vs ≤0.05 ng/mL/h) was a significant independent predictor of 3-year cardiac morbidity/mortality, MI, MI +CHF hospitalization and all-cause death, plus long-term (mean 6.4 years) CHF and all-cause death (Table⇓). PRA category 2/3 vs 1 (>0.5 vs ≤0.5 ng/mL/h) also predicted 3-year cardiac morbidity/mortality (HR 2.13, p=0.03), long-term CHF (HR 3.07, p=0.006) and death (HR 1.88, p=0.005). Tertile analysis yielded similar results. In conclusion, in women with CAD (≥50% stenosis) but normal left ventricular function and no history of MI, elevated PRA is an independent predictor of short-term MI, cardiac morbidity/mortality and all-cause death, and long-term CHF hospitalization and death.