Aldosterone status associates with insulin resistance in patients with heart failure-data from the ALOFT study

Freel, E.M., Tsorlalis, I.K., Lewsey, J.D., Latini, R., Maggioni, A.P., Solomon, S., Pitt, B., Connell, J.M.C. and McMurray, J.J.V. (2009) Aldosterone status associates with insulin resistance in patients with heart failure-data from the ALOFT study. Heart, 95(23), pp. 1920-1924. (doi:10.1136/hrt.2009.173344)

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Publisher's URL: http://dx.doi.org/10.1136/hrt.2009.173344

Abstract

<b>Background</b>: Aldosterone plays a key role in the pathophysiology of heart failure. In around 50% of such patients, aldosterone 'escapes' from inhibition by drugs that interrupt the renin-angiotensin axis; such patients have a worse clinical outcome. Insulin resistance is a risk factor in heart failure and cardiovascular disease. The relationship between aldosterone status and insulin sensitivity was investigated in a cohort of heart failure patients. <b>Methods</b>: 302 patients with New York Heart Association (NYHA) class II-IV heart failure on conventional therapy were randomized in ALiskiren Observation of heart Failure Treatment study (ALOFT), designed to test the safety of a directly acting renin inhibitor. Plasma aldosterone and 24-hour urinary aldosterone excretion as well as fasting insulin and Homeostasis model assessment of insulin resistance (HOMA-IR) were measured. Subjects with aldosterone escape and high urinary aldosterone were identified according to previously accepted definitions. <b>Results</b>: Twenty per-cent of subjects demonstrated aldosterone escape and 34% had high urinary aldosterone levels. At baseline, there was a positive correlation between fasting insulin and plasma(r=0.22 p<0.01) and urinary aldosterone(r=0.19 p<0.03). Aldosterone escape and high urinary aldosterone subjects both demonstrated higher levels of fasting insulin (p<0.008, p<0.03), HOMA-IR (p<0.06, p<0.03) and insulin-glucose ratios (p<0.006, p<0.06) when compared to low aldosterone counterparts. All associations remained significant when adjusted for potential confounders. <b>Conclusions</b>: This study demonstrates a novel direct relationship between aldosterone status and insulin resistance in heart failure. This observation merits further study and may identify an additional mechanism that contributes to the adverse clinical outcome associated with aldosterone escape.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lewsey, Professor Jim and McMurray, Professor John and Connell, Professor John and Freel, Dr Marie
Authors: Freel, E.M., Tsorlalis, I.K., Lewsey, J.D., Latini, R., Maggioni, A.P., Solomon, S., Pitt, B., Connell, J.M.C., and McMurray, J.J.V.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:26 August 2009
Copyright Holders:Copyright © 2009 British Medical Journal Publishing Group
First Published:First published in Heart 95(23):1920-1924
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
392521Regulation of aldosterone and cortisol synthesis in hypertension and cardiovascular diseaseEleanor DaviesMedical Research Council (MRC)G0400874Institute of Cardiovascular and Medical Sciences
392522Regulation of aldosterone and cortisol synthesis in hypertension and cardiovascular diseaseEleanor DaviesMedical Research Council (MRC)G0400874Institute of Cardiovascular and Medical Sciences