PMID- 19713201
OWN - NLM
STAT- MEDLINE
DCOM- 20091217
LR  - 20211020
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 95
IP  - 23
DP  - 2009 Dec
TI  - Aldosterone status associated with insulin resistance in patients with heart 
      failure--data from the ALOFT study.
PG  - 1920-4
LID - 10.1136/hrt.2009.173344 [doi]
AB  - BACKGROUND: Aldosterone has a key role in the pathophysiology of heart failure. 
      In around 50% of such patients, aldosterone "escapes" from inhibition by drugs 
      that interrupt the renin-angiotensin axis; such patients have a worse clinical 
      outcome. Insulin resistance is a risk factor in heart failure and cardiovascular 
      disease. The relation between aldosterone status and insulin sensitivity was 
      investigated in a cohort of heart failure patients. METHODS: 302 patients with 
      New York Heart Association (NYHA) class II-IV heart failure on conventional 
      therapy were randomised in the ALiskiren Observation of heart Failure Treatment 
      study (ALOFT), designed to test the safety of a directly acting renin inhibitor. 
      Plasma aldosterone and 24-hour urinary aldosterone excretion, as well as fasting 
      insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were 
      measured. Subjects with aldosterone escape and high urinary aldosterone were 
      identified according to previously accepted definitions. RESULTS: 20% of subjects 
      demonstrated aldosterone escape and 34% had high urinary aldosterone levels. At 
      baseline, there was a positive correlation between fasting insulin and plasma (r 
      = 0.22 p<0.01) and urinary aldosterone(r = 0.19 p<0.03). Aldosterone escape and 
      high urinary aldosterone subjects both demonstrated higher levels of fasting 
      insulin (p<0.008, p<0.03), HOMA-IR (p<0.06, p<0.03) and insulin-glucose ratios 
      (p<0.006, p<0.06) when compared to low aldosterone counterparts. All associations 
      remained significant when adjusted for potential confounders. CONCLUSIONS: This 
      study demonstrates a novel direct relation between aldosterone status and insulin 
      resistance in heart failure. This observation merits further study and may 
      identify an additional mechanism that contributes to the adverse clinical outcome 
      associated with aldosterone escape.
FAU - Freel, E M
AU  - Freel EM
AD  - BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 
      8TA, UK. E.Freel@clinmed.gla.ac.uk
FAU - Tsorlalis, I K
AU  - Tsorlalis IK
FAU - Lewsey, J D
AU  - Lewsey JD
FAU - Latini, R
AU  - Latini R
FAU - Maggioni, A P
AU  - Maggioni AP
FAU - Solomon, S
AU  - Solomon S
FAU - Pitt, B
AU  - Pitt B
FAU - Connell, J M C
AU  - Connell JM
FAU - McMurray, J J V
AU  - McMurray JJ
LA  - eng
GR  - G0400874/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090826
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Insulin)
RN  - 4964P6T9RB (Aldosterone)
RN  - EC 3.4.23.15 (Renin)
SB  - IM
MH  - Aged
MH  - Aldosterone/*metabolism
MH  - Diabetes Mellitus/metabolism
MH  - Fasting/blood
MH  - Female
MH  - Heart Failure/drug therapy/*metabolism
MH  - Homeostasis
MH  - Humans
MH  - Insulin/blood
MH  - Insulin Resistance/*physiology
MH  - Male
MH  - Middle Aged
MH  - Renin/antagonists & inhibitors
EDAT- 2009/08/29 09:00
MHDA- 2009/12/18 06:00
CRDT- 2009/08/29 09:00
PHST- 2009/08/29 09:00 [entrez]
PHST- 2009/08/29 09:00 [pubmed]
PHST- 2009/12/18 06:00 [medline]
AID - hrt.2009.173344 [pii]
AID - 10.1136/hrt.2009.173344 [doi]
PST - ppublish
SO  - Heart. 2009 Dec;95(23):1920-4. doi: 10.1136/hrt.2009.173344. Epub 2009 Aug 26.