1] Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA [2] Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Hypertens Res. 2013 Oct;36(10):895-901. doi: 10.1038/hr.2013.45. Epub 2013 May 9.
Recent data suggest excess circulating aldosterone promotes cardiometabolic decline. Weight loss may lower aldosterone levels, but little longitudinal data is available in normotensive adults. We aimed to determine whether, independent of changes in sodium excretion, reductions in serum aldosterone are associated with favorable changes in obesity-related factors in normotensive overweight/obese young adults. We studied 285 overweight/obese young adult participants (body mass index ≥ 25 and<40 kg m⁻², age 20-45 years) in a clinical trial examining the effects of a 1-year diet and physical activity intervention with or without sodium restriction on vascular health. Body weight, serum aldosterone, 24-h sodium and potassium excretion and obesity-related factors were measured at baseline, 6, 12 and 24 months. Weight loss was significant at 6 (7%), 12 (6%) and 24 months (4%; all P<0.0001). Decreases in aldosterone were associated with decreases in C-reactive protein, leptin, insulin, homeostasis assessment of insulin resistance, heart rate, tonic cardiac sympathovagal balance and increases in adiponectin (all P<0.05) in models adjusting for baseline age, sex, race, intervention arm, time since baseline, and sodium and potassium excretion. Weight loss and reductions in thigh intermuscular fat (intermuscular adipose tissue area; IMAT) were associated with decreases in aldosterone in the subgroup (n=98) with metabolic syndrome (MetS) at baseline (MetS × weight loss, P=0.04; MetS × change in IMAT, P=0.04). Favorable changes in obesity-related factors are associated with reductions in aldosterone in young adults with no risk factors besides excess weight, an important finding, given aldosterone's emergence as an important cardiometabolic risk factor.
最近的数据表明，循环醛固酮过多会促进心脏代谢衰退。减轻体重可能会降低醛固酮水平，但在血压正常的成年人中，很少有纵向数据可用。我们旨在确定在血压正常的超重/肥胖年轻成年人中，独立于钠排泄变化，血清醛固酮的降低是否与肥胖相关因素的有利变化相关。我们在一项临床试验中研究了 285 名超重/肥胖的年轻成年参与者（体重指数≥25 且<40 kg/m²，年龄 20-45 岁），该试验检查了 1 年饮食和体育活动干预加或不加钠限制对血管健康的影响。在基线、6、12 和 24 个月时测量体重、血清醛固酮、24 小时钠和钾排泄以及肥胖相关因素。体重减轻在 6 个月（7%）、12 个月（6%）和 24 个月（4%）时均显著（所有 P<0.0001）。在调整基线年龄、性别、种族、干预臂、自基线以来的时间以及钠和钾排泄的模型中，醛固酮的降低与 C 反应蛋白、瘦素、胰岛素、胰岛素抵抗的稳态评估、心率、紧张性心脏交感神经平衡以及脂联素的增加相关（所有 P<0.05）。在基线时患有代谢综合征（MetS）的亚组（n=98）中，体重减轻和大腿肌间脂肪（肌间脂肪组织面积；IMAT）的减少与醛固酮的减少相关（MetS×体重减轻，P=0.04；MetS×IMAT 的变化，P=0.04）。除超重以外，没有其他危险因素的年轻成年人中，肥胖相关因素的有利变化与醛固酮的降低相关，这是一个重要的发现，因为醛固酮已成为一个重要的心脏代谢危险因素。
