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Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A

Ying Jing1, Kangla Liao2, Ruolin Li1

  • 1Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Journal of the Renin-Angiotensin-Aldosterone System : JRAAS
|March 23, 2021
PubMed

Insights

Surgical treatment for primary aldosteronism (PA) lowers cardiovascular disease (CVD) and mortality risks compared to medical management. Medically treated PA patients face higher CVD risks than essential hypertension patients.

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Surgical Oncology

Background:

  • Primary aldosteronism (PA) is associated with increased cardiovascular disease (CVD) risk.
  • Optimal treatment strategies for PA, balancing efficacy and safety, remain an area of active research.
  • Comparing surgical versus medical management is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the comparative effectiveness of surgical versus mineralocorticoid receptor antagonist (MRA)-based medical treatment in patients with primary aldosteronism.
  • To assess the impact of treatment modality on the incidence of cardiovascular diseases (CVD) and all-cause mortality.

Main Methods:

  • A meta-analysis was conducted using data from PUBMED, MEDLINE, and the Cochrane Library.
  • Included were patients diagnosed with PA via guideline-supported protocols, treated surgically or medically (MRA-based).
  • Age- and sex-matched patients with essential hypertension (EH) served as a control group.

Main Results:

  • Patients with treated PA exhibited a higher CVD risk (OR 1.79) than EH patients, primarily driven by medically treated PA (OR 2.11).
  • Surgically treated PA patients did not show an elevated CVD risk compared to EH.
  • All-cause mortality risk was lower in treated PA patients (OR 0.86) versus EH, notably in the surgically treated group (OR 0.47).

Conclusions:

  • Medically treated primary aldosteronism is linked to increased cardiovascular disease risk compared to essential hypertension.
  • Surgical intervention for primary aldosteronism significantly reduces the risk of both cardiovascular events and all-cause mortality.
Abstract

Keywords:
Primary aldosteronismadrenal surgeryall-cause mortalitycardiovascular diseasesmineralocorticoid receptor antagonist

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