Sex Differences in Cardiac Remodeling and Dysfunction in Primary Aldosteronism

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.