The involvement of
angiotensin II,
cortisol and
aldosterone in increased cardiovascular risk is well known but their interactions within arterial wall and during
atheroma formation are not established. In fact, mild
cortisol excess is associated with a higher prevalence of cardiovascular events, increased intima media thickness, a higher frequency of
atherosclerotic plaques and increased mortality. Conversely, remission from
hypercortisolism is followed by improvement in cardiovascular risk markers as intima-media thickness or arterial distensibility, suggesting a strong link between
cortisol excess and adverse
vascular remodeling. On the other hand, implication of renin-angiotensin system (RAS) in atheromatous remodeling is well documented. The RAS also includes
aldosterone, a
mineralocorticoid which secretion is mainly and strongly stimulated by
angiotensin II, and which receptor (MR) can also be activated by
cortisol given that MR affinity is similar for both
aldosterone and
cortisol. The role of
aldosterone in arterial remodeling is still very controversial.
Aldosterone treatment associated with a high
salt diet induced not only
hypertension but also oxidative stress,
collagen synthesis and vascular
inflammation. However in models without
salt loading or arterial
hypertension, such as the treatment with
deoxycorticosterone acetate in dogs, no alterations in aortic structure were observed and moreover, the MR blockade with
eplerenone did not attenuate
atherosclerosis in the aorta of diabetic
Apo-E KO mice. It stems that among the different effects and mechanisms described in cell experiments, it is not known which are indeed operating in situ in human vessels and thus, if local
cortisol is deleterious or beneficial and, if activation of MR by
aldosterone or
cortisol is important in
vascular remodeling and
atherogenesis. RAS blocker treatment would be particularly beneficial in essential hypertensive patients with low plasma
renin, to attenuate both
angiotensin II and also
cortisol up-regulation.