Vasculometabolic and Inflammatory Effects of Aldosterone in Obesity.

CONTEXT Not all obese individuals develop cardiovascular disease (CVD). Hyperaldosteronism is suggested to cause inflammation and metabolic dysregulation, and might contribute to CVD development in obese individuals. OBJECTIVE We aimed to investigate the association of aldosterone concentrations with inflammation, metabolic disturbances, and atherosclerosis in overweight and obese individuals. Additionally, we measured renin concentrations, to investigate if the observed effects reflected general activation of the renin-angiotensin-aldosterone system (RAAS). DESIGN Cross-sectional cohort study (300-OB study). Various inflammatory parameters, traits of the metabolic syndrome, lipidome and metabolome parameters, fat distribution, and carotid atherosclerosis were associated with plasma aldosterone and renin levels. SETTING Radboudumc, the Netherlands. PATIENTS 302 individuals with a BMI≥27kg/m2. MAIN OUTCOME MEASURES AND RESULTS Aldosterone associated with various markers of inflammation and metabolic dysregulation, which partly differed from the associations observed for renin. While both associated with inflammatory cell numbers, only renin associated with classical markers of systemic inflammation. Both associated with the metabolic syndrome and hepatic steatosis. Of the traits that constitute the metabolic syndrome, aldosterone, but not renin, associated with triglyceride concentrations. In line, aldosterone associated with large VLDL particles; metabolomics studies further associated aldosterone with urate concentrations and derivatives of the linoleic acid metabolism pathway. Neither aldosterone nor renin associated with atherosclerotic plaque thickness. CONCLUSIONS aldosterone is not an important driver of systemic inflammation in the obese, while aldosterone concentrations and metabolic dysregulation are strongly intertwined in these individuals. Although prospective studies are necessary to validate these results, the independent effects of aldosterone on carotid atherosclerosis appear modest.