Lipid Profile in Primary Aldosteronism: Cross-Sectional and Post-Treatment Analyses

The relationship between primary aldosteronism (PA) and lipid metabolism remains controversial, with inconsistent findings reported in the literature. This study aimed to clarify PA's impact on the lipid profile using both a cross-sectional comparison with essential hypertension (EH) controls and a longitudinal within-patient pre-post treatment analysis in a North African tertiary-center cohort. This retrospective study included 112 patients with PA and 115 contemporaneously hospitalized patients with EH in whom secondary hypertension had been excluded. Sociodemographic, clinical, and biochemical variables (fasting blood glucose, HbA1c, lipid profile, creatinine, potassium, baseline aldosterone levels, and aldosterone-to-renin ratio), as well as therapeutic data, were collected at admission in both groups. In the PA group, clinical and biological parameters performed 1 year after specific PA management were recorded. Triglyceride levels were significantly higher in patients with PA not receiving lipid-lowering therapy (1.47 (1.13-1.92) vs. 1.24 (1.02-1.69) mmol/L; p = 0.04) but this difference disappeared after multivariable adjustment for age, sex, BMI, and fasting glucose. A baseline aldosterone level > 200 pg/mL was associated with lower triglyceride levels (1.35 (1.02-1.81) vs. 1.81 (1.35-2.15) mmol/L; p = 0.01). Patients with PA who underwent adrenalectomy demonstrated a significant increase in triglyceride levels at 1 year (1.52 (1.32-2.11) vs. 2.08 (1.38-2.50) mmol/L; p = 0.04). The estimated glomerular filtration rate declined significantly 1 year after PA specific treatment (84.9 ± 19.7 vs. 73.6 ± 24.9 mL/min/1.73 m²; p < 0.01). Our findings show mixed associations between aldosterone and triglyceride levels, which require confirmation in prospective studies.