Type 2 diabetes (T2D) continues to rise among African Americans (AAs). However, it has been observed to be higher among non-Hispanic whites (NHWs). In addition, mortality and morbidity related to T2D have also been reported to be higher among AAs than NHWs. Therefore, evaluating new factors to understand differences in the prevalence, incidence, and mortality of TSD among AAs is necessary.
One such risk factor is aldosterone, which has been shown to be associated with increased cardiovascular disease (CVD), diabetes, and all-cause mortality among AAs. The American Heart Association launched the 7th Heart Health Index in 2010, divided into 4 health behaviors (diet, exercise, weight, and smoking) and 3 health factors (glycemia, total cholesterol, and blood pressure) ). The classification of the regions was done in good, poor, and medium categories, followed by their classification into scoring systems.
The REasons for Geographic Aand Racial Dsettings in Schange (LOOK) study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study (JHS) reported the association of ICH (ideal cardiovascular health) with a lower risk of diabetes among AAs. Furthermore, advanced ICH was reported to be associated with decreased aldosterone levels among AAs in JHS. However, studies on the mediation of aldosterone in the association of ICH and T2D incidence are limited. Reduction of aldosterone may be a mechanism by which advanced ICH reduces the incidence of T2D.
A new study in American Journal of Preventive Cardiology aimed to evaluate the role of aldosterone as a mediator in the association of ICH and T2DF incidence among AAs in JHS. The association of aldosterone with T2D incidence among AAs was also analyzed using glucose and blood pressure as mediators.
Study: The Role of Aldosterone and Ideal Cardiovascular Health in Incident Diabetes: The Jackson Heart Study. Photo credit: Kateryna Kon / Shutterstock
About this study
The study involved 5,306 AA adults from the JHS study who were between the ages of 21 and 94. The baseline and enrollment examinations were conducted between 2000 and 2004, while two follow-up examinations were conducted between 2005 and 2008 and 2009 and 2013. total cholesterol, body mass index (BMI), physical activity (PA), diet, and smoking.
Measurement of total cholesterol was performed using the cholesterol oxidase method. Body mass index was calculated by dividing weight (kilograms) by the square of height (meters). Physical Action Assessment (PA) was assessed using a PA questionnaire administered by the interviewer at baseline. Smoking was a self-report measure in which participants were asked about the duration and frequency of smoking. Dietary assessment was conducted using the Delta Nutrition Intervention Research Initiative questionnaire. Analysis of each baseline metric was conducted separately using the good, poor, and moderate groups.
Fasting blood samples were collected from all participants for aldosterone measurement by radioimmunoassay. Blood pressure was measured twice at 5-minute intervals, and fasting plasma concentration was measured using the colorimetric method of glucose oxidase. The definition of T2D included fasting blood glucose ≥ 126 mg/dl, HbA1c ≥ 6.5%, taking diabetes medication, or self-reported to a physician. Information on education, occupation, demographics, prescription drug use, alcohol consumption, and eGFR was also collected.
Study your findings
The results show that a total of 2,791 people were included in the study, of which 2,364 had 0 to 2 episodes of ICH and 427 had ≥3 episodes of ICH. The participants were observed to have higher education, kidney function, and functional activities and lower systolic BP, fasting glucose, total cholesterol, and BMI. Median serum aldosterone levels were reported to be 4.00 ng/dL in participants with ≥3 ICH and 4.3 ng/dL in participants with 0 to 2 ICH. In addition, 447 cases of diabetes were reported in groups 0 to 2 ICH and 50 in groups ≥3 ICH during the follow-up period.
Participants in groups of ≥3 ICH were reported to have a 37% lower risk of developing diabetes. 6.98% of the results of the five metrics of ICH were reported to be in the middle of aldosterone. Increased aldosterone was found to be associated with a higher risk of diabetes. Furthermore, the effects of aldosterone on diabetes were observed to be associated with fasting glucose and BP. A significant interaction of eGFR, age, and sex was observed for the 3 ICH groups with diabetes. Participants with 2 ICH metrics were considered to have a 20% lower risk while those with ≥3 ICH metrics had a 44% lower risk of diabetes compared to those with 0-1 ICH metrics.
Therefore, the present study suggests that aldosterone may mediate the association of ICH and diabetes among AAs. Therefore, targeting aldosterone in early prevention and implementing other lifestyle changes can reduce the risk of diabetes. Further research is needed to evaluate aldosterone and other biological factors in the development of T2D.
This study has some limitations. First, the results of this study are not known. Second, no other species/species are included in this study for comparison. Third, this study did not include renin and other factors that may affect the RAAS system and aldosterone.