Prevalence And Clinical Features Of Cardiometabolic Diseases In Patients With Primary Aldosteronism

BackgroundStudies have found that compared with patients with essential hypertension(EH),patients with primary aldosteronism(PA)have a significantly increased risk of cardiometabolic disease(CMD)such as cardio-cerebrovascular diseases(CVD)and metabolic syndrome(MS).This study was conducted to preliminarily understand the prevalence and clinical characteristics of CMD in PA patients,and also to investigate the possible influencing factors of CVD and MS in the PA population.Materials and MethodsIn this study,305 patients diagnosed with PA in Nanfang Hospital of Southern Medical University from January 2010 to December 2020 were included according to the inclusion and exclusion criteria,and their basic data,laboratory tests and imaging examinations were collected for systematic retrospective analysis.SPSS 25.0 software was used to describe PA patients,and groups were performed according to different criteria such as age,gender,serum potassium and different subtypes to compare the clinical characteristics of PA patients in different groups and their incidence of CMD;at the same time,groups were analyzed and compared according to the presence or absence of CVD and MS,and multivariate logistic regression was used to analyze the possible influencing factors of PA with CVD or MS.P<0.05 was considered statistically significant.Result1.A total of 305 patients with PA were collected in this study,with a male to female ratio of about 1:1.05 and an age of onset of 48±11 years.In this study,mean plasma aldosterone(ALD)and plasma aldosterone/renin ratio(ARR)were higher than normal levels,plasma renin activity(PRA)was lower than normal levels,and mean serum potassium was 3.25± 0.59 mmol/L.The prevalence of PA patients with MS or CVD was 25.9%and 20.9%,respectively.2.The results of age and gender comparison showed that there was no significant difference in ALD,PRA,ARR,serum potassium and hypertension history(P>0.05).Compared with<50y or female patients,≥50y or male patients had statistically significant difference in the prevalence of CVD and MS(P<0.05).3.Compared with PA patients with grade Ⅰ and Ⅱ hypertension,the incidence of hypokalemia and CVD in patients with grade Ⅲ hypertension was significantly higher(27.0%vs 17.2%,P=0.04),while patients with grade Ⅰ and Ⅱ hypertension had the highest incidence of MS(34.4%vs 17.5%,P<0.01).Compared with patients without a history of hypokalemia,PA patients with a history of hypokalemia were more common in men,had higher ALD and ARR,lower PRA,a higher proportion of hypertension,and a more than 3-fold higher prevalence of CVD(24.2%vs 7.1%,P<0.01),but there was no significant difference in the prevalence of MS.4.Comparison of groups based on AVS classification revealed that ALD and ARR were higher in the unilateral subtype than in the bilateral subtype.In addition,there was no significant difference in age,gender,glucose and lipid metabolism indicators and prevalence of CMD between the two groups.Similar findings were observed in the treatment-based group with increased ALD and ARR and decreased serum potassium in the surgical treatment group,and there were also significant differences in serum sodium and 24-hour urinary potassium levels between the two groups.5.Compared with the non-CVD group,the CVD group had a higher male proportion,age and BMI,duration of hypertension,serum creatinine,uric acid,blood glucose,and HDL-C,and was more likely to have hypokalemia and aortic sclerosis.Logistic regression analysis suggested that duration of hypertension(P=0.045)and interventricular septal thickness(P=0.046)may be the influencing factors for CVD in PA patients.6.Compared with the non-MS group,the proportion of males,age,BMI,duration of hypertension,serum creatinine,uric acid and TG,blood glucose and HbA1c were higher in the MS group,and they were more likely to be associated with overweight/obesity,diabetes/prediabetes and fatty liver.Logistic regression analysis suggested that BMI(P=0.001),blood uric acid(P=0.049),posterior wall comfort thickness(P=0.044)and the presence or absence of fatty liver(P=0.009)may be the influencing factors of MS in PA patients.Conclusion1.PA patients are prone to have CMD,about half of whom are overweight/obese,about one-fifth have CVD,and about one-fourth have MS.PA patients over 50 years of age,male were more likely to have CMD;while PA patients with grade Ⅲ hypertension or a history of hypokalemia were more likely to have CVD.2.There was no significant difference in the prevalence of CMD between lateral/bilateral subtype determined according to AVS,while the incidence of MS was higher in PA patients treated with drugs.3.The duration of hypertension and interventricular septum end-diastolic thickness are the main influencing factors of PA with CVD;BMI,blood uric acid,fatty liver and posterior wall end-diastolic thickness are the main influencing factors of PA with MS.