Obesity, aldosterone, and natriuretic peptides in patients with heart failure and reduced ejection fraction

Experimental evidence suggests that adipose tissue may secrete aldosterone, and mineralocorticoid receptor antagonists (MRAs) appear to be more effective in patients with obesity. Therefore, we examined aldosterone levels according to measures of adiposity in patients with heart failure and reduced ejection fraction (HFrEF) participating in two large trials.

Aldosterone, N-terminal pro B-type natriuretic peptide (NT-proBNP), and B-type natriuretic peptide (BNP) levels were compared according to body mass index (BMI) categories: normal weight (<25.0 kg/m²), overweight (25.0–29.9 kg/m²), obesity class I (30.0–34.9 kg/m²), and obesity class II/III (≥35.0 kg/m²). Of the 2201 patients not treated with an MRA, in whom aldosterone levels were measured at baseline in ATMOSPHERE and PARADIGM-HF, the mean age was 67.8 years, and 440 (20.0%) were female. Patients with higher BMI had a higher left ventricular ejection fraction but worse New York Heart Association functional class than those with normal weight. Higher BMI was associated with higher aldosterone levels but lower NT-proBNP and BNP levels (P for trend < 0.001), compared to those with normal weight. This natriuretic peptide trend was also seen for other anthropometric measures.

Greater adiposity was associated with higher concentrations of aldosterone but lower levels of B-type natriuretic peptides in patients with HFrEF. Adipose tissue may influence the neurohumoral milieu in HFrEF, including the secretion of aldosterone.