Patients with Primary Aldosteronism (PA) Face Increased Cardiovascular Risks and Mortality, Study Finds
Patients with primary aldosteronism (PA), a hormonal disorder that affects the adrenal glands, are at a higher risk of cardiovascular complications and mortality, according to a recent study. The study, which is the first to report the incidence of cardiovascular events and all-cause mortality in coronary artery disease-naive patients with PA, found that after a mean follow-up period of 5.8 years, the incidence rate of new-onset composite cardiovascular events was 10.9 per 1000 person-years, and the incidence rate of all-cause mortality was 5.7 per 1000 person-years.
PA is characterized by excessive production of the hormone aldosterone, which leads to high blood pressure and imbalances in the body’s sodium and potassium levels. Previous studies have shown that patients with PA have a higher prevalence of baseline coronary artery disease at diagnosis, as well as an increased risk of long-term cardiovascular morbidity and mortality.
The study also examined the association between kidney function and cardiovascular outcomes in patients with PA. It was found that decreased estimated glomerular filtration rate (eGFR), a measure of kidney function, was independently associated with increased cardiovascular disease and mortality in both the general population and patients with essential hypertension. However, untreated patients with PA had higher eGFR levels compared to patients with essential hypertension, which could mask actual kidney dysfunction in some cases.
The researchers used the newly developed 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate eGFR in patients with PA. This equation, which does not incorporate race as a variable, provides accurate estimations of kidney function and overcomes racial disparities in GFR estimation.
The study also highlighted the importance of prompt nephrology referral and comprehensive evaluations of kidney function in patients with PA, especially those with baseline eGFR levels below 85 mL/min/1.73 m. Successful treatment of PA, such as adrenalectomy or targeted medications, has been shown to alleviate long-term progressive kidney injury caused by excessive aldosterone secretion.
While the study has some limitations and cannot establish a causal relationship between baseline eGFR and cardiovascular outcomes, it sheds light on the increased cardiovascular risks and mortality faced by patients with PA. The findings reinforce the need for early detection, comprehensive management, and individualized treatment strategies for this patient population.
In conclusion, patients with primary aldosteronism (PA) have an increased risk of cardiovascular complications and mortality. A recent study found that these patients have a higher prevalence of baseline coronary artery disease at diagnosis and a higher risk of long-term cardiovascular morbidity and mortality. The study also highlighted the importance of prompt nephrology referral and comprehensive evaluations of kidney function in patients with PA. Successful treatment of PA has been shown to alleviate long-term progressive kidney injury. These findings contribute to a better understanding of the cardiovascular risks faced by patients with PA and emphasize the need for individualized management strategies.
