Plasma Aldosterone Concentration as a Determinant for Statin Use among Middle-Aged Hypertensive Patients for...

Area of Science:

• Cardiology
• Endocrinology
• Preventive Medicine

Background:

• Statin therapy is recommended for atherosclerotic cardiovascular disease (ASCVD) prevention by the American College of Cardiology (ACC) and American Heart Association (AHA).
• Validation of statin therapy recommendations in primary aldosteronism (PA) patients is lacking.
• PA is associated with increased cardiovascular risk compared to essential hypertension (EH).

Purpose of the Study:

• To investigate the risk of incident ASCVD in middle-aged patients with PA compared to EH.
• To evaluate the ACC/AHA guidelines' discriminative power for ASCVD prediction in PA patients.
• To identify specific biomarkers that may indicate benefit from early statin therapy in PA.

Main Methods:

• Comparative study of 461 PA patients and 553 EH patients.
• Assessment of cardiovascular risk factors including blood pressure, lipid profiles, and metabolic syndrome.
• Utilized ACC/AHA guidelines for statin therapy recommendations and receiver operating characteristic (ROC) curve analysis to determine discriminative power.
• Employed generalized additive models to analyze the association between plasma aldosterone concentration (PAC) and ASCVD risk.

Main Results:

• The PA group exhibited higher systolic blood pressure, lower high-density lipoprotein levels, and higher 10-year ASCVD risk compared to the EH group.
• The ACC/AHA guidelines demonstrated strong discriminative power for predicting ASCVD in the PA group (ROC curve: 0.94 (0.91⁻0.96)).
• Patients with PAC > 60 ng/dL were identified as high-risk individuals who may benefit from early statin therapy, aligning with ACC/AHA recommendations.

Conclusions:

• The ACC/AHA guidelines are effective in predicting ASCVD risk in middle-aged hypertensive patients, including those with PA.
• Plasma aldosterone concentration (PAC) serves as a valuable biomarker for identifying PA patients who could benefit from proactive statin therapy.
• Early statin intervention guided by PAC levels may be crucial for mitigating ASCVD risk in PA patients.