Altered Morning Aldosterone Response May Signal Higher Cardiovascular Risk in Men: Study Suggests
Germany: Researchers have found that the salivary free aldosterone awakening response (AldAR) differs significantly among men with coronary heart disease (CHD), essential hypertension, and normotension, and that higher AldAR levels may signal an increased future risk of cardiovascular disease.
The findings are from a study published in Frontiers in Endocrinology by Angelina Gideon from the University of Konstanz, Germany, and colleagues, highlighting the potential role of early-morning aldosterone dynamics in cardiovascular risk assessment.
Aldosterone, a mineralocorticoid hormone, plays a central role in blood pressure regulation and fluid balance and has long been implicated in the development of cardiovascular disease. However, how short-term fluctuations in biologically active aldosterone relate to long-term cardiovascular risk has remained unclear. To address this gap, the researchers examined the awakening response of salivary free aldosterone in men with established CHD, those with essential hypertension, and healthy normotensive controls, and further explored whether AldAR could predict changes in key biological risk markers over time.
The cross-sectional component of the study included 144 male participants: 60 patients with CHD, 40 with essential hypertension, and 44 normotensive controls. Salivary aldosterone was measured on two consecutive days immediately after awakening and again at 15, 30, 45, and 60 minutes thereafter, allowing the investigators to characterize both overall aldosterone levels and the dynamic post-awakening response. In addition, 97 participants were followed prospectively for an average of nearly three years to assess changes in inflammatory markers and blood lipid profiles associated with coronary heart disease risk.
The analysis revealed the following findings:
- Distinct salivary aldosterone awakening response (AldAR) patterns were observed among the study groups.
- Men with normotension showed the expected post-awakening rise in aldosterone levels.
- Patients with essential hypertension had higher overall aldosterone concentrations but a flattened AldAR, indicating disruption of normal hormonal regulation.
- Men with coronary heart disease demonstrated a typical AldAR pattern, but with lower overall aldosterone levels compared with healthy normotensive controls.
- These group differences in AldAR patterns remained evident even after adjusting for potential confounding factors.
- Higher AldAR area under the curve was independently associated with greater increases in inflammatory parameters over time.
- Elevated AldAR was linked to increases in low-density lipoprotein cholesterol and total cholesterol levels.
- After adjustment for covariates, the associations with lipid parameters weakened to trend-level significance.
- The strongest associations were observed between higher AldAR and markers of systemic inflammation and dyslipidemia, both key contributors to atherosclerotic cardiovascular disease.
Taken together, the findings suggest that an exaggerated or dysregulated aldosterone awakening response may serve as an early biological indicator of increased cardiovascular risk. As the authors noted, altered AldAR patterns could reflect underlying pathophysiological processes that promote inflammation and adverse lipid changes.
"While further studies are needed to confirm these observations and explore clinical applications, salivary AldAR measurement may eventually offer a noninvasive tool to improve cardiovascular risk stratification in men with or at risk for heart disease," they concluded.
Reference:
Gideon, A., Von Känel, R., Degroote, C., Thomas, L., Zuccarella-Hackl, C., Wiest, R., & Wirtz, P. H. (2026). Salivary free aldosterone awakening response and cardiovascular risk in men with CHD, hypertension, and healthy controls. Frontiers in Endocrinology, 16, 1655896. https://doi.org/10.3389/fendo.2025.1655896
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