High Levels of Aldosterone Increase Risk of Diabetes

Type 2 diabetes mellitus incidence has plateaued among non‐Hispanic whites (NHWs) but continues to rise among racial/ethnic minorities in the USA. Thus, novel preventive intervention targets are of paramount importance, one potential target is the renin‐angiotensin‐aldosterone (RAAS) system.

Scientists at the Ohio State University (Columbus, OH, USA) and their colleagues studied a population‐based sample of 6,814 men and women from four racial/ethnic groups: NHWs (38%), African Americans (28%), Chinese Americans (12%), and Hispanic Americans (22%). Participants were aged 45 to 84 years at baseline without evidence of clinical cardiovascular disease. The mean age was 64 ± 10 years and 51% were female.

Serum glucose was measured by rate reflectance spectrophotometry using thin film adaptation of the glucose oxidase method on the Vitros analyzer. Insulin was determined using a radioimmunoassay Linco Human Insulin Specific RIA Kit. The homeostasis model assessment (HOMA)‐2 of insulin resistance (HOMA2‐IR) and β‐cell function (HOMA2‐β) were calculated using the updated computer‐based HOMA index of insulin resistance (HOMA2‐IR) and computer‐based HOMA2‐β%. Aldosterone was measured using a competition‐based radioimmunoassay.

The team reported that there were 116 cases of incident diabetes mellitus over 10.5 years among 1,570 adults. A 100% increase in log‐aldosterone was associated with a 2.6 mg/dL higher fasting plasma glucose, 15% higher HOMA2‐IR and 6% higher HOMA2‐β. A 1‐SD increase in log‐aldosterone was associated with a 44% higher risk of incident diabetes mellitus with the greatest increase of 142% observed in Chinese Americans.

The authors concluded that aldosterone is associated with glucose homeostasis and diabetes mellitus risk with graded associations among Chinese Americans and African Americans, suggesting that pleiotropic effects of aldosterone may represent a modifiable mechanism in diabetes mellitus pathogenesis with potential racial/ethnic variation.

Joshua J. Joseph, MD, the lead investigator, said, “We know there’s a relationship between aldosterone and type 2 diabetes. Now we need to determine thresholds that will guide clinical care and the best medication for treatment.” The study was published on September 4, 2018, in the Journal of the American Heart Association.

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