Title: Association of aldosterone with mortality in the general population.

Abstract

Aldosterone excess is linked to cardiovascular events and mortality as well as to low-grade inflammation in the context of metabolic diseases. Whether mildly elevated aldosterone levels in the general population promote cardiovascular risk is still under debate. We analyzed the association of plasma aldosterone concentrations with incident cardiovascular events, cardiovascular and all-cause mortality as well as with biomarkers of subclinical inflammation in the population-based KORA F4 study. Plasma aldosterone concentrations were measured with an inhouse immunoflurometric assay. The analyses included 2935 participants (n = 1076 for selected biomarkers of subclinical inflammation) with a median follow-up of 8.7 (8.2; 9.1) years. The associations were estimated using Cox proportional hazard and linear regression models adjusted for renin, sex, age, BMI, arterial hypertension, diabetes, estimated glomerular filtration rate, low- and high-density lipoprotein cholesterol, physical activity, smoking, use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, diuretics and calcium channel blockers. Aldosterone was significantly associated with all-cause mortality (hazard ratio per standard deviation increase: 1.20; 95% confidence interval 1.04-1.37), but not with cardiovascular mortality or incident cardiovascular events, nor with biomarkers of subclinical inflammation. Aldosterone was associated with all-cause mortality, but the previously described associations of excess aldosterone with cardiovascular complications and biomarkers of subclinical inflammation could not be shown in the population-based KORA F4 study.