Sleep Disordered Breathing as an Independent Predictor of Post-Discharge Mortality in Patients with Acutely Decompensated Heart Failure

Abstract

Introduction: Aldosterone promotes sodium and water retention and mediates inflammation and fibrosis. Aldosterone may be inappropriately high in hypertensive patients and recent studies have established that it may be higher in obese subjects and in the metabolic syndrome (MetS), although within the normal range. To date, aldosterone concentrations in the general population and the relationship to co-morbidities as well as metabolic and cardiorenal parameters have not been well defined. Hypothesis: We hypothesized that aldosterone levels correlate with the prevalence of cardiorenal and metabolic diseases in a general community including metabolic parameters and cardiac structure.Methods:We evaluated the association between aldosterone levels, cardiometabolic parameters and cardiorenal disease in a general community-based cohort from Olmsted County, MN (1674 subjects 45 years and older). We also assessed cardiac structure and function by echocardiography. Results: Median level of aldosterone was 4.6 ng/dl (Q1 2.50, Q3 8.00 ng/dl). Multivariate analysis adjusted for age, gender, BMI and ANP showed a significant correlation between aldosterone levels and hypertension (p!0.0001, OR52.28, CI:1.91-2.71), atrial fibrillation (p!0.01, OR51.53, CI:1.11-2.11), chronic kidney disease (CKD) (p!0.0001, OR51.64, CI:1.33-2.02), central obesity (p!0.0001, OR51.61, CI:1.27-2.05), hypertriglyceridemia (p!0.003, OR51.27, CI:1.08-1.48), prevalence of MetS (p!0.0007, OR51.40, CI51.15-1.71) and obesity (p!0.0001, OR51.48, CI:1.27-1.73). These associations remained significant even after including BNP levels in the multivariate regression models. Aldosterone levels were also associated with concentric hypertrophy and preserved left ventricular ejection fraction. Conclusions: In a general community-based cohort from Olmsted County MN, aldosterone is powerfully associated with cardiovascular, renal and metabolic diseases including alterations in cardiac structure. Specifically, aldosterone was strongly associated with hypertension, CKD, atrial fibrillation, obesity, MetS per se as well as its individual components. This study strongly supports aldosterone as a marker for human cardiorenal and metabolic diseases and/or as a potential mediator of these diseases even in the general adult population prior to over disease. Further studies are warranted to evaluate possible therapeutic interventions targeting aldosterone as a strategy to delay disease progression.