SAT-055 The Aldosterone-Renin Ratio Predicts Cardiometabolic Disorders in Subjects without Classic Primary Aldosteronism

Abstract

Background: Aldosterone has been linked with obesity, metabolic syndrome (MetS), pro-inflammatory and pro-thrombotic states. However, most of these studies relate to patients with evident primary aldosteronism (PA). Objective: To determine whether aldosterone, renin or the plasma aldosterone/renin ratio (ARR) are associated with metabolic disorders and inflammatory/vascular biomarkers in a no-PA population. Methods: We studied 275 patients including adolescents and adults of both genders and measured aldosterone in plasma and urine and determined the plasma renin activity (PRA). In all subjects, the presence of MetS was determined according to Adult Treatment Panel III. Renal, vascular, inflammatory and mineralocorticoid activity biomarkers were evaluated. Results: The ARR correlated with the number of variables of MetS (r=0.191, p=0.002), BMI (r=0.136, p=0.026), SBP (r=0.183, p=0.002), DBP (r=0.1917, p=0.0014), potassium excreted fraction (r=0.174, p=0.004), LDL (r=0.156, p=0.01), PAI-1 (r=0.158, p=0.009), microalbuminuria (r=0.136, p=0.029), and leptin (r=0.142, p=0.019). In a linear regression model adjusted by age, BMI and gender, only the ARR was significant (r= 0.108, p= 0.05). In a logistic regression analysis, the ARR predicted MetS index (OR 1.07 [CI 1.011- 1.131] p= 0.02) even after adjusting for age, BMI and gender. On the other hand, aldosterone showed no association with MetS nor inflammatory markers. Conclusion: These results suggest a continuum of cardiometabolic risk beyond the classic PA threshold screening. We believe that the ARR seems to be a more sensitive marker of obesity, MetS and endothelial damage in non-PA patients than aldosterone or renin alone. More prospective studies are needed to develop future screening values.