The Balance Between the Natriuretic Peptides and the Renin-Angiotensin-Aldosterone System in the Preservation of Ideal Cardiovascular Health

A healthy lifestyle plays a key role for maintaining the cardiovascular health (CVH) status and prevent cardiovascular disease occurrence. In fact, a healthy lifestyle was included in the AHA Cardiovascular Health score (Life’s Simple 7 [LS7]), subsequently updated to Life’s Simple 8 [LS8]. Apart from the importance of controlling conventional cardiovascular risk factors, increasing evidence supports the contributory role of cardiovascular hormones. Higher levels of natriuretic peptides (NPs) and lower levels of renin and aldosterone were significantly associated to CVH. NT-proBNP levels showed a direct relationship with CVH scores in large general Caucasian populations, being also a marker of CVH changes and a predictor of future adverse events. On the other hand, renin and aldosterone were inversely related to CVH scores. In contrast, the counter-regulatory angiotensins [Ang (1-7) acting through Mas receptor, Ang (1-9) acting through Angiotensin Type 2 receptor, and alamandine] strengthen the beneficial properties of NPs. This evidence can be explained by both the effects on systemic hemodynamic and possible pleiotropic local functions regulating different pathways involved in the maintenance of CVH. Based on the current evidence, circulating levels of NT-proBNP, renin and aldosterone may affect CVH in apparently asymptomatic individuals and represent additional markers of residual cardiovascular risk.