Cardiac Structure and Function Across the Spectrum of Aldosteronism: the Atherosclerosis Risk in Communities Study

Area of Science:

• Cardiology
• Endocrinology
• Clinical Research

Background:

• Aldosterone and mineralocorticoid receptor activation are linked to myocardial fibrosis and cardiovascular events.
• Primary aldosteronism is a condition characterized by excessive aldosterone production.

Purpose of the Study:

• To investigate the association between markers of primary aldosteronism and cardiac structure, function, and clinical outcomes.
• To explore renin suppression and aldosterone levels as potential indicators of cardiovascular risk.

Main Methods:

• Analysis of 4547 participants from the ARIC study without prevalent heart failure.
• Echocardiography, aldosterone, and plasma renin activity measurements were performed.
• Cross-sectional and longitudinal analyses assessed relationships with cardiac parameters and outcomes like heart failure hospitalization and atrial fibrillation.

Main Results:

• Primary aldosteronism physiology was prevalent (11.6%) and associated with cardiac structural and functional changes.
• Renin suppression correlated with increased left ventricular mass, volumes, and atrial volume, and a lower E/A ratio.
• Higher aldosterone levels were linked to increased left ventricular mass, reduced global longitudinal strain, and a higher risk of incident atrial fibrillation.

Conclusions:

• Renin suppression and aldosterone excess, indicative of primary aldosteronism, are associated with cardiac alterations.
• These findings suggest that primary aldosteronism pathophysiology may be an early target for therapeutic intervention with mineralocorticoid receptor antagonists to mitigate fibrosis.