Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease.
Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease.
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DOI：
10.1161/hypertensionaha.114.03936
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发表时间：
2015-01
期刊：
影响因子：
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通讯作者：
Burnett JC Jr
中科院分区：
文献类型：
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作者：
Buglioni A;Cannone V;Cataliotti A;Sangaralingham SJ;Heublein DM;Scott CG;Bailey KR;Rodeheffer RJ;Dessì-Fulgheri P;Sarzani R;Burnett JC Jr
我们试图研究醛固酮作为疾病介质的作用及其与反调节利钠肽（NP）系统的关系。我们测量了来自明尼苏达州奥姆斯特德县普通人群的随机样本（n=1674;年龄≥45岁）的血浆醛固酮。在多变量logistic回归模型中，醛固酮作为连续变量分析与高血压（HTN）相关（OR=1.75，95%CI= 1.57，1.96; p<0.0001），肥胖（OR=1.34，95%CI= 1.21，1.48; p<0.0001），慢性肾脏病（CKD）（OR=1.39，95%CI= 1.22，1.60; p<0.0001），中心性肥胖（OR=1.47，95%CI= 1.32，1.63; p<0.0001），代谢综合征（MetS）（OR=1.41，95%CI= 1.26，1.58; p<0.0001），高甘油三酯（OR=1.23，95%CI= 1.11，1.36; p<0.0001），向心性左室肥厚（cLVH）（OR=1.22，95%CI= 1.09，1.38; p=0.0007）和房颤（OR=1.24，95%CI= 1.01，1.53; p=0.04）。在进一步调整BMI、NP和肾功能后，与HTN、中心性肥胖、MetS、甘油三酯和cLVH的相关性仍然显著。此外，最高三分位数的醛固酮与较低的NP水平和死亡率增加相关。重要的是，即使排除了醛固酮水平高于正常范围的受试者，这些相关性中的大多数仍然显著。总之，我们报告醛固酮与HTN、CKD、肥胖、代谢综合征、cLVH和一般社区中较低的NP相关。我们的数据表明，醛固酮，即使在正常范围内，可能是心肾和代谢疾病的生物标志物。进一步的研究是必要的，以评估一种治疗和预防策略，以延迟疾病的发作和/或进展，使用盐皮质激素拮抗剂或长期NP管理的高风险受试者确定的血浆醛固酮。
We sought to investigate the role of aldosterone as a mediator of disease and its relationship with the counter-regulatory natriuretic peptide (NP) system. We measured plasma aldosterone (n=1674; age ≥45 years old) in a random sample of the general population from Olmsted County, MN. In a multivariate logistic regression model, aldosterone analyzed as a continuous variable was associated with hypertension (HTN) (OR=1.75, 95%CI= 1.57,1.96; p<0.0001), obesity (OR=1.34, 95%CI= 1.21,1.48; p<0.0001), chronic kidney disease (CKD) (OR=1.39, 95%CI= 1.22,1.60; p<0.0001), central obesity (OR=1.47, 95%CI=1.32,1.63; p<0.0001), metabolic syndrome (MetS) (OR=1.41, 95%CI= 1.26,1.58; p<0.0001), high triglycerides (OR=1.23, 95%CI=1.11,1.36; p<0.0001), concentric left ventricular hypertrophy (cLVH) (OR=1.22, 95%CI= 1.09,1.38; p=0.0007) and atrial fibrillation (OR=1.24, 95%CI= 1.01,1.53; p=0.04), after adjusting for age and sex. The associations with HTN, central obesity, MetS, triglycerides and cLVH remained significant after further adjustment for BMI, NPs, and renal function. Furthermore, aldosterone in the highest tertile correlated with lower NP levels and increased mortality. Importantly, most of these associations remained significant even after excluding subjects with aldosterone levels above the normal range. In conclusion, we report that aldosterone is associated with HTN, CKD, obesity, MetS, cLVH, and lower NPs in the general community. Our data suggests that aldosterone, even within the normal range, may be a biomarker of cardiorenal and metabolic disease. Further studies are warranted to evaluate a therapeutic and preventive strategy to delay the onset and/or progression of disease, using mineralocorticoid antagonists or chronic NP administration in high risk subjects identified by plasma aldosterone.