Relationship of plasma aldosterone levels and carbohydrate metabolism in heart failure with preserved ejection fraction

Aim. To determine the relationship between the blood aldosterone levels and parameters of carbohydrate metabolism in patients with heart failure (HF) with preserved ejection fraction (HFpEF).

Material and methods. This cross-sectional study included 158 patients with stable HFpEF. HFpEF was established in the presence of symptoms and/or signs of HF, left ventricular ejection fraction >50%, increased blood NT-proBNP levels, and characteristic structural cardiac changes according to echocardiography. The study did not include patients with primary hyperaldosteronism and those taking mineralocorticoid receptor antagonists within the previous 6 weeks. In all patients, the blood aldosterone and carbohydrate metabolism parameters were assessed. The aldosterone levels were determined by the enzyme immunoassay and the concentration of 40-160 pg/ml was considered the reference values. Diabetes was diagnosed in the following cases: history of diabetes, treatment with antidiabetic drugs, blood glucose level ≥7,0 mmol/L in two samples or glycated hemoglobin (HbA_1c) >6,5%. Prediabetes was recorded if the blood glucose level in a patient without diabetes was in the range of ≥5,6 mmol/L and<7,0 mmol/L.

Results. In 99 patients (62,7%, group 1), the aldosterone levels were within the normal range, while in the remaining 59 patients (37,3%, group 2), it exceeded the upper limit. Patients with hyperaldosteronemia compared with those with normal aldosterone levels had significantly higher fasting plasma glucose levels (6,60 (6,00-7,90) mmol/L vs 5,80 (5,25-6,80) mmol/L, p<0,001) and HOMA value (5,86±1,12 vs 4,46±1,02, p=0,01). HbA1c levels did not differ significantly between groups. Patients of the 2^nd group more often suffered from diabetes (39,0% vs 19,2%, p<0,001) and hyperglycemia in general (89,8% vs 61,6%, p=0,011) compared with patients of the 1^st group. Correlation analysis showed a significant relationship between the level of aldosterone and blood glucose (r=0,29), HbA_1c (r=0,17) and HOMA (r=0,23) values. After standardization by age, HF class, body mass index, blood pressure, cholesterol and blood potassium levels in multivariate analysis, the presence of hyperaldosteronemia was significantly correlated with diabetes (odds ratio, 1,64, 95% confidence interval, 1,14-3,32, p=0,013) and hyperglycemia (odds ratio, 2,84, 95% confidence interval, 1,94-14,2, p=0,008). Conclusion. The development of secondary hyperaldosteronism in patients with HFpEF is associated with a significant increase in the risk of hyperglycemia and diabetes.

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