Prognostic Value of Plasma Aldosterone Levels on the Future Risk of New-Onset Atrial Fibrillation

Background: Renin-angiotensin-aldosterone system has been reported as one of the risk factors of atrial fibrillation (Af). However, roles of aldosterone (ALD) and predictor of new-onset Af are still unclear. We therefore evaluated predictive value of plasma ALD levels on the incidence of Af. Methods: The levels of plasma ALD were quantified in a prospective cohort study of 796 consecutive outpatient clinic patients initially free from Af (age 68.5±12.6). The subjects were divided into two groups of elevated ALD group (group H) and non-elevated ALD group (group L) according to the median value of baseline plasma ALD. The end point of the study was new-onset Af. Results: The median value of baseline ALD was 89.0 pg/mL in all patients. During a median follow-up of 941 days, incidence of new-onset Af was 7.5%. Patients of group H had a significantly higher Af incidence rates, as compared to those of group L (12.5% vs. 2.5%, P<0.0001). Elevated ALD were independent predictor of increased future incident Af risk in Cox regression analyses adjusted for age, sex, body mass index, C-reactive protein and brain natriuretic peptide. The adjusted hazard ratio was 3.691 (95% CI, 1.962–6.942; P<0.0001). Conclusions: In Japanese patients without Af, higher ALD was independent predictor of developing Af.