Vasopressin and cardiometabolic disease : is water a new prevention strategy ?

Vasopressin (VP), commonly proxie-measured with a stable C-terminal fragment of the precursor hormone called copeptin, is elevated not only in cases of acute diseases with severe water losses (e.g gastroenteritis) or hypotension (e.g septic shock) but also in normal states when water intake is low. This preserves normal plasma osmolality thanks to renal water conservation through VP stimulation of the V2 receptor. However, as will be demonstrated in this talk, high levels of copeptin in the population is linked to markedly increased risk of type 2 diabètes melitus, cardiovascular disease and chronic kidney disease independently of other risk factors. Moreover, obese individuals with high copeptin are at increased risk of non-alcoholic fatty liver disease (NAFLD). A challenging question based on the hypothesis that high VP (measuring by copeptin) is causally related to these diseases, is whether the elevation of cardiometabolic risk in normal subjects with high VP and other signs of low water intake (low urine volume and high urine osmolality) can be reversed by water supplementation. Data from animals and humans to support this hypothesis will be presented.