Prevalence of Cardiovascular Disease and Its Risk Factors in Primary Aldosteronism

Author:

Ohno Youichi1,Sone Masakatsu1,Inagaki Nobuya1,Yamasaki Toshinari1,Ogawa Osamu1,Takeda Yoshiyu1,Kurihara Isao1,Itoh Hiroshi1,Umakoshi Hironobu1,Tsuiki Mika1,Ichijo Takamasa1,Katabami Takuyuki1,Tanaka Yasushi1,Wada Norio1,Shibayama Yui1,Yoshimoto Takanobu1,Ogawa Yoshihiro1,Kawashima Junji1,Takahashi Katsutoshi1,Fujita Megumi1,Watanabe Minemori1,Matsuda Yuichi1,Kobayashi Hiroki1,Shibata Hirotaka1,Kamemura Kohei1,Otsuki Michio1,Fujii Yuichi1,Yamamoto Koichi1,Ogo Atsushi1,Okamura Shintaro1,Miyauchi Shozo1,Fukuoka Tomikazu1,Izawa Shoichiro1,Yoneda Takashi1,Hashimoto Shigeatsu1,Yanase Toshihiko1,Suzuki Tomoko1,Kawamura Takashi1,Tabara Yasuharu1,Matsuda Fumihiko1,Naruse Mitsuhide1,Kawaguchi Takahisa,Setoh Kazuya,Matsuda Fumihiko,Takahashi Yoshimitsu,Nakayama Takeo,Kosugi Shinji, ,

Affiliation:

1. From the Department of Diabetes, Endocrinology, and Nutrition (Y. Ohno, M.S., N.I.) and Department of Urology (T. Yamasaki, O.O.), Kyoto University, Japan; Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Japan (Y. Takeda); Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K., H.I.); Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (H.U., M.T., M.N...

Abstract

There have been several clinical studies examining the factors associated with cardiovascular disease (CVD) in patients with primary aldosteronism (PA); however, their results have left it unclear whether CVD is affected by the plasma aldosterone concentration or hypokalemia. We assessed the PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) and compared the prevalence of CVD among patients with PA with that among age-, sex-, and blood pressure-matched essential hypertension patients and participants with hypertension in a general population cohort. We also performed binary logistic regression analysis to determine which parameters significantly increased the odds ratio for CVD. Of the 2582 patients with PA studied, the prevalence of CVD, including stroke (cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage), ischemic heart disease (myocardial infarction or angina pectoris), and heart failure, was 9.4% (stroke, 7.4%; ischemic heart disease, 2.1%; and heart failure, 0.6%). The prevalence of CVD, especially stroke, was higher among the patients with PA than those with essential hypertension/hypertension. Hypokalemia (K + ≤3.5 mEq/L) and the unilateral subtype significantly increased adjusted odds ratios for CVD. Although aldosterone levels were not linearly related to the adjusted odds ratio for CVD, patients with plasma aldosterone concentrations ≥125 pg/mL had significantly higher adjusted odds ratios for CVD than those with plasma aldosterone concentrations <125 pg/mL. Thus, patients with PA seem to be at a higher risk of developing CVD than patients with essential hypertension. Moreover, patients with PA presenting with hypokalemia, the unilateral subtype, or plasma aldosterone concentration ≥125 pg/mL are at a greater risk of CVD and have a greater need for PA-specific treatments than others.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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