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; aged≥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 (odds ratio [OR]=1.75; 95% confidence interval [CI]=1.57-1.96; P<0.0001),
obesity (OR=1.34; 95% CI=1.21-1.48; P<0.0001),
chronic kidney disease (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 (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 (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
hypertension,
central obesity,
metabolic syndrome,
triglycerides, and concentric
left ventricular hypertrophy remained significant after further adjustment for body mass index, 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
hypertension,
chronic kidney disease,
obesity,
metabolic syndrome, concentric
left ventricular hypertrophy, and lower NPs in the general community. Our data suggest 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 progression of disease, using
mineralocorticoid antagonists or chronic NP administration in high-risk subjects identified by plasma
aldosterone.