Plasma aldosterone and long-term myocardial remodeling: a 10-year prospective analysis from the Tanushimaru Cohort

The renin-angiotensin-aldosterone system plays a central role in myocardial fibrosis and cardiac remodeling; however, longitudinal evidence regarding its association with long-term changes in left ventricular mass index (LVMI) in community-based populations remains limited. We investigated whether baseline plasma aldosterone concentration (PAC), plasma active renin concentration (ARC), and the aldosterone-to-renin ratio (ARR) were associated with 10-year LVMI progression in community-dwelling adults not receiving antihypertensive therapy. This longitudinal study included 539 participants (179 men and 360 women) from the Tanushimaru cohort in Japan who underwent health examinations in both 2009 and 2018. PAC and ARC were measured by radioimmunoassay, and LVMI was calculated using the Devereux formula. Multivariable logistic regression analyses were performed to evaluate the association between baseline PAC and LVMI progression over 10 years. Baseline PAC was not significantly associated with LVMI progression when analyzed as a continuous variable in fully adjusted models. Analyses of ARC and ARR also showed no significant associations with LVMI progression. Restricted cubic spline analysis suggested an increased risk at higher PAC, although the overall association did not reach statistical significance. Receiver operating characteristic analysis identified an exploratory cutoff value of 109.95 pg/mL. Participants with baseline PAC ≥ 110 pg/mL had a significantly increased risk of LVMI progression over 10 years after multivariable adjustment (odds ratio 1.86, 95% confidence interval 1.21-2.84; p = 0.0045). These findings suggest that higher PAC may be associated with myocardial structural remodeling in the general population.