Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study

Aims Previous studies relating plasma renin to cardiovascular disease (CVD) and mortality yielded conflicting results. We related plasma renin to incidence of CVD and mortality in 3408 individuals (mean age 59; 53% women) and in a hypertensive subset (n = 1413). Methods and results On follow-up (mean 7.1 years), 176 participants (122 hypertensives) developed CVD and 215 individuals (127 hypertensives) died. Overall, log-renin was associated with mortality [multivariabte-adjusted hazards ratio (HR) per SD increment: in whole sample, 1.14, 95% confidence interval (Cl) 1.00-1.30, P=0.046; hypertensives, 1.16, 95% Cl 1.00-1.35, P=0.046], but relations varied over time (P < 0.02). Log-renin was associated with mortality at 2.5 years of follow-up (HR per SD increment: whole sample at 2.5 years, 1.23, 95% Cl 1.04-1.45; hypertensives at 2 years, 1.28, 95% Cl 1.06-1.54), but not during longer follow-up (HR per SD increment at 5 years: whole sample, 1.02, 95% Cl 0.80-1.29; hypertensives, 0.98, 95% Cl 0.74-1.30). The time-dependent relation of renin and mortality risk was maintained upon excluding participants with prevalent CVD. Renin was not associated with CVD incidence (HR per SD increment log-renin: whole sample, 0.99, 95% Cl 0.85-1.14; hypertensives, 0.96, 95% Cl 0.82-1.12). Conclusion Higher plasma renin was associated with greater short-term mortality but not with CVD incidence in the community.