The Relationship Between Ischemic Stroke And Aldosterone

Part? Primary Aldosteronism in Patients with Acute Ischemic StokeObjective: To explore the characteristics of primary aldosteronism(PA)in patients with acute ischemic stroke.Methods: A total of 403 patients with acute ischemic stroke were divided into two groups which included 19 patients with primary aldosteronism and 384 patients without primary aldosteronism.Clinical characteristics were compared between two groups.Results: Patients with primary aldosteronism had higher blood pressure(systolic P=0.015,diastolic P=0.007),lower potassium concentration(P<0.001).There were no differences in ischemic stroke subtypes between patients with and without primary aldosteronism.Only 6 patients(31.6%)had potassium concentrations below the lower limit of normal(3.5mmol/L).There was no significant difference between the two groups in the proportion of patients with each TOAST type.Conclusion: The prevalence of primary aldosteronism is not low among acute ischemic stroke patients.It is significant to pay more attention to the possibility of the existence of primary aldosteronism in acute ischemic patients.Efficient screening of primary aldosteronism should be performed for patients with relevant risk factors.Part? Plasma Aldosterone Is Associated with Cerebral Arterial Stenosis and CalcificationObjective: Elevated plasma aldosterone concentration is known to be linked with elevated risk of cerebrovascular events as a result of vascular senescence.We studied the association between plasma aldosterone concentration and cerebral arteriosclerosis status involving cerebral atherosclerosis burden and cerebral vascular calcification.Methods: A total of 207 patients(mean age=62.40±10.54,70 female patients)admitted with acute ischemic stroke from a single center-based stroke registry were included in the study.The participants were categorized into four groups in accordance to the plasma aldosterone concentration.Cerebral atherosclerosis burden was derived as the stenosis degree of main cerebral arteries,and cerebral artery calcification was investigated from the cavernous portions of both internal carotid arteries from brain computed tomography angiography.Results: The median aldosterone was 146.00 pg/ml;interquartile range was 133.18 to 172.10 pg/ml.Advanced cerebral arterial stenosis was present in 134 patients(64.7%)and advanced cerebral arterial calcification was present in 77 patients(37.2%).The prevalence of cerebral atherosclerosis burden and cerebral artery calcification showed increasing tendency through the aldosterone quartiles.Multivariable logistic regression analysis including age,sex,vascular risk factors,estimated glomerular filtration rate and aldosterone quartiles disclosed that the highest plasma aldosterone quartile was an independent predictor of advanced cerebral atherosclerosis(odds ratio,5.07;95% confidence interval,1.82-14.17;Ptrend=0.001)and advanced intracranial arterial calcification(odds ratio,6.24;95% confidence interval,2.03-19.22;Ptrend=0.001).Conclusion: An increased plasma aldosterone concentration was independently associated with cerebral atherosclerosis burden and arterial calcification.Future studies should investigate whether aldosterone antagonists prevent stroke in at risk population.