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Biomarkers of the renin-angiotensin-aldosterone system as predictors of heart failure in obese patients

Bogdanov A. R., Zaletova T. S., Sentsova T. B., Golubeva A. A., Shcherbakova M. Yu.

Keywords: neurohumoral status, obesity, renin-angiotensin system, heart failure

DOI: 10.18087/rhfj.2014.3.1922

Background. At the present time, obesity is recognized as a major risk factor (RF) of cardiovascular diseases (CVD). Aim. To study pathogenetic mechanisms of neurohumoral activation and their significance for development of HF in obesity. Materials and methods. 78 obese patients were evaluated and divided into two groups, the main group (n=40) consisting of patients with grade 3 obesity (mean BMI, 53.2 kg / m2) and the reference group (n=38) consisting of patients with grade 1 and 2 obesity (mean BMI, 35.9 kg / m2). Clinical and functional manifestations of CHF were studied; plasma levels of N-terminal fragment of brain natriuretic peptide (NT-proBNP), aldosterone, renin and angiotensin II (AII) were measured. These parameters were evaluated at admission and after 14 days of low-calorie, low-sodium diet therapy. Results. 46.2 % of patients with grade 1 and 2 obesity and 85.7 % of patients with grade 3 obesity had increased plasma levels of aldosterone in combination with normal renin and moderately increased AII. Patients with grade 3 obesity had significantly higher plasma levels of aldosterone than patients with grade 1 and 2 obesity (25.9 %, р <0.05). Levels of aldosterone were closely correlated with levels of NT-proBNP (r=0.74, р <0.05) and severity of HF as assessed by the clinical status scale (r=0.54, р <0.05). The low-calorie and low-sodium diet therapy induced a highly significant increase in aldosterone by 23.4 % in patients with grade 1 and 2 obesity (р <0.001) and by 51.2 % (p <0.001) in patients with grade 3 obesity. In addition, patients with grade 3 obesity had two times higher blood level of renin (р=0.01). Conclusion. Progression of obesity is associated with secondary hyperaldosteronism. Plasma levels of aldosterone and renin should be taken into account in selection of treatment tactics for obese patient. If these levels are increased, an appropriate drug therapy should be administered.
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Bogdanov A.R., Zaletova T.S., Sentsova T.B. et al. Biomarkers of the renin-angiotensin-aldosterone system as predictors of heart failure in obese patients. Russian Heart Failure Journal. 2014;84 (3):160–166

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