Aldosterone and Cardiovascular Risk Across the Lifespan

Area of Science:

• Endocrinology
• Cardiology
• Nephrology

Background:

• Aldosterone excess, especially primary aldosteronism, is linked to poor cardiovascular outcomes.
• Historically, primary aldosteronism was associated with resistant hypertension and hypokalemia, leading to delayed diagnosis and end-organ damage.
• Recent findings show a broad spectrum of renin-independent aldosteronism, from subclinical to severe forms.

Purpose of the Study:

• To review the cardiovascular consequences of aldosterone excess.
• To explore the mechanisms of cardiac remodeling in primary aldosteronism.
• To examine the cardiovascular risks associated with renin-independent aldosteronism across different age groups.

Main Methods:

• This is a narrative review.
• The review synthesizes current research on aldosterone excess and cardiovascular health.
• It discusses pathophysiological mechanisms and clinical implications.

Main Results:

• Primary aldosteronism leads to adverse cardiovascular events, independent of blood pressure levels.
• Subclinical primary aldosteronism is associated with early cardiac remodeling, even in young adults.
• Patients with primary aldosteronism face higher cardiovascular morbidity and mortality than those with essential hypertension.

Conclusions:

• Timely diagnosis of primary aldosteronism is crucial for reducing cardiovascular risk.
• Mineralocorticoid receptor antagonists can effectively mitigate the cardiovascular complications of aldosterone excess.
• Understanding the spectrum of renin-independent aldosteronism is key to managing cardiovascular risk throughout life.