Role of aldosterone in obesity: Excessive aldosterone is produced by adrenal glands and adipose tissue in obesity. This explains the sensitivity of heart failure (HF) in obesity to mineralocorticoid receptor antagonists (MRA) .
Epicardial fat thickness has been shown to be increased in primary hyperaldosteronism . So aldosterone secretion enhances fat deposition and fat deposits enhance aldosterone secretion. Primary hyperaldosteronism is associated with increased left ventricular mass and cardiovascular risk. Transition of epicardial fat from a nourishing tissue to proinflammatory tissue is mediated by aldosterone. Proinflammatory cytokines and migration of mesenchymal cells have a role in cardiac fibrosis. This will explain the role of mineralocorticoid antagonists in preventing cardiac fibrosis in cardiac failure situations. Experimental studies also support the role of aldosterone in the genesis of cardiac hypertrophy and fibrosis in metabolic syndrome .
Packer M. Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium. J Am Coll Cardiol. 2018 May 22;71(20):2360-2372.