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Sex Differences in Cardiac Remodeling and Dysfunction in Primary Aldosteronism.

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Men and women with primary aldosteronism show distinct cardiac remodeling patterns. While structural changes improved similarly after treatment, women experienced less improvement in diastolic function, highlighting sex-specific cardiovascular risks.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Sex Differences in Medicine

Background:

  • Sex influences cardiovascular risk, but its role in aldosterone-mediated cardiac remodeling in primary aldosteronism is not fully understood.
  • Primary aldosteronism is a key driver of cardiovascular disease, linked to cardiac remodeling.
  • Understanding sex-specific effects is crucial for targeted risk assessment and management.

Purpose of the Study:

  • To investigate sex differences in aldosterone-mediated cardiac remodeling in primary aldosteronism.
  • To compare baseline cardiac characteristics and treatment response between men and women.
  • To explore the association between plasma aldosterone concentration and cardiac remodeling markers in a sex-specific manner.

Main Methods:

  • Retrospective study of 547 patients with primary aldosteronism (249 men, 298 women).
  • Collection of clinical and echocardiographic data at baseline and 1 year post-treatment.
  • Multivariable analyses and sex-stratified models to assess associations and interactions.

Main Results:

  • Women had higher baseline left ventricular hypertrophy prevalence and worse diastolic function (higher E/e', left atrial volume index) despite lower left ventricular mass index (LVMI).
  • Plasma aldosterone concentration correlated with baseline LVMI in both sexes, and with diastolic indices in men only.
  • After treatment, LVMI reduction was similar, but diastolic function (E/e') improved less in women; LAVI decreased in men but not women.

Conclusions:

  • Sex-specific differences exist in cardiac remodeling and diastolic function in primary aldosteronism.
  • Women present a more adverse cardiac phenotype at baseline, with poorer diastolic function improvement post-treatment.
  • Aldosterone-targeted therapies yield similar structural regression but differential diastolic functional recovery between sexes.