Cardiovascular outcomes and all-cause mortality in primary aldosteronism after adrenalectomy or mineralocorticoid receptor antagonist treatment: a meta-analysis

Chen, Sheng-Yin; Chen, Jui-Yi; Huang, Wei‐Chieh; Puar, Troy; Kek, Peng Chin; Chueh, Jeff S; Lin, Yen-Hung; Wu, Vin-Cent; Group, TAIPAI Study

doi:10.1530/eje-22-0375

Cited by 24 publications

(23 citation statements)

References 48 publications

(83 reference statements)

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“…Adrenalectomy, when feasible, has shown, over the year, its superiority over medical treatment for the prevention of major cardiovascular events, all-cause mortality, and improvement of quality of life. 22,23 Most predictors of clinical success are only risk factors of essential hypertension, probably concomitant with primary aldosteronism. 24 Biological success (ie, a normal postsurgery ARR) should be the most regarded parameter.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Primary Aldosteronism in France from 2010 to 2020, Results from the French-Speaking Association of Endocrine Surgery (AFCE) - Eurocrine® Study Group

et al. 2023

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Objective: Describe the diagnostic work-up and postoperative results for patients treated by adrenalectomy for primary aldosteronism in France from 2010 to 2020 Summary Background Data: Primary aldosteronism (PA) is the underlying cause of hypertension in 6-18% patients. French and international guidelines recommend CT-scan and adrenal vein sampling as part of diagnostic work-up to distinguish unilateral PA amenable to surgical treatment, from bilateral PA that will require lifelong antialdosterone treatment. Adrenalectomy for unilateral primary aldosteronism has been associated with complete resolution of hypertension (no antihypertensive drugs and normal ambulatory pressure) in about 1/3 of patients, and complete biological success in 94% of patients. These results are mainly based on retrospective studies with short follow-up and aggregated patients from various international high volume centres. Methods: Here we report results from French-Speaking Association of Endocrine Surgery (AFCE) using the Eurocrine® Database. Results: Over 11 years, 385 patients from 10 medical centres were eligible for analysis, accounting for >40% of adrenalectomies performed in France for primary aldosteronism over the period. Preoperative work-up was consistent with guidelines for 40% patients. Complete clinical success (CCS) at last follow-up was achieved in 32% patients and complete biological success was not sufficiently assessed. For patients with two follow-up visits, clinical results were not persistent at one year for 1/5 patients. Factors associated with CCS on multivariate analysis were body mass index, duration of hypertension and number of antihypertensive drugs. Conclusions: These results call for an improvement in thorough preoperative work-up and long-term follow-up of patients (clinical and biological) to early manage hypertension and/or PA relapse.

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Section: Discussionmentioning

confidence: 99%

Surgery for Primary Aldosteronism in France from 2010 to 2020, Results from the French-Speaking Association of Endocrine Surgery (AFCE) - Eurocrine® Study Group

et al. 2023

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“…Several studies have shown beneficial effects on cardiovascular comorbidities in patients with PA treated with unilateral adrenalectomy. 13,15,16 Furthermore, previous studies have indicated that all-cause mortality in surgically treated patients with PA is not increased and may in fact be lower than the mortality risk in patients with essential hypertension or in patients receiving medical treatment for PA. 15,16,26,27 These results are in line with our study, showing that mortality in patients treated with unilateral adrenalectomy is similar to age- and sex-matched controls. However, comparing mortality in patients receiving medical and surgical treatment may be misleading, given that medically treated patients are older and more often have clinically manifest cardiovascular diseases when PA is diagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…12 However, the mean follow-up time in the largest study, which included 2448 patients (ie, 81% of the patients that were included in the meta-analysis) was 4.3 years compared with 8 years in our study. 16 Thus, reliable data on mortality during long-term follow-up have not been available from previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…There are only a few studies on mortality in patients with PA and often limited by small numbers and selected patient populations treated at large referral centers. 15,16 The extent to which age and comorbidities at diagnosis, sex, and treatment modality influence long-term mortality is largely unknown. Therefore, we aimed to determine all-cause and cause-specific mortality in a large unselected cohort of patients diagnosed with PA in Sweden between 1997 and 2019, compared with an age- and sex-matched cohort from the background population.…”

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confidence: 99%

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Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study

Gkaniatsa,

Zverkova Sandström,

Rosengren

et al. 2023

Hypertension

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BACKGROUND: Primary aldosteronism (PA) is associated with increased mortality. The extent to which this phenomenon is affected by gender, age, comorbidities at diagnosis, and different treatment modalities is largely unknown. The objective was to determine all-cause and cause-specific mortality in a population-based cohort of patients with PA and the impact of age at diagnosis, sex, comorbidities, and treatment modalities. METHODS: We used national registers to identify patients diagnosed with PA between 1997 and 2019 (n=2419) and controls (n=24 187) from the general population, matched for sex, age, and county of residence. We obtained mortality data from the Cause-of-Death Register. We used Cox regression models, adjusted for socioeconomic factors and diabetes, to estimate adjusted hazard ratios (HRs [95% CI]). RESULTS: Overall, 346 (14.3%) patients with PA and 2736 (11.3%) controls died during a median follow-up time of 8.1 years. PA was associated with increased risk from all-cause mortality (HR, 1.23 [95% CI, 1.10–1.38]), death from cardiovascular disease (HR, 1.57 [95% CI, 1.30–1.89]), and stroke (HR, 1.85 [95% CI, 1.16–2.93]). Patients with cardiovascular disease at diagnosis (HR, 1.53 [1.26–1.85]), age >56 years (HR, 1.28 [95% CI, 1.13–1.45]), patients treated with a low dose of a mineralocorticoid receptor antagonist (HR, 1.30 [95% CI, 1.02–1.66]), and untreated patients (HR, 2.51 [95% CI, 1.72–3.67]) had excess mortality. CONCLUSIONS: Mortality, mainly due to cardiovascular disease, is increased in patients with PA compared with controls from the general population, particularly in patients aged >56 years, patients with preexisting cardiovascular comorbidities, and patients receiving low dose of a mineralocorticoid receptor antagonist.

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“…However, this is not helpful to predict the cure rate or long-term prognosis before surgery. Although adrenalectomy currently is preferred for patients with PA concerning the risk of all-cause mortality and major adverse cardiovascular events compared to medical treatment ( 129 ), predicting the types of mutations with simple and safe methods before surgery would possibly allow physicians to make a comprehensive treatment strategy for patients. Future studies are needed to explore the most appropriate diagnostic methods.…”

Section: Kcnj5 Somatic Mutationsmentioning

confidence: 99%

Cardiovascular and metabolic characters of KCNJ5 somatic mutations in primary aldosteronism

Chang

Lee²,

Chen³

et al. 2023

Front. Endocrinol.

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BackgroundPrimary aldosteronism (PA) is the leading cause of curable endocrine hypertension, which is associated with a higher risk of cardiovascular and metabolic insults compared to essential hypertension. Aldosterone-producing adenoma (APA) is a major cause of PA, which can be treated with adrenalectomy. Somatic mutations are the main pathogenesis of aldosterone overproduction in APA, of which KCNJ5 somatic mutations are most common, especially in Asian countries. This article aimed to review the literature on the impacts of KCNJ5 somatic mutations on systemic organ damage.Evidence acquisitionPubMed literature research using keywords combination, including “aldosterone-producing adenoma,” “somatic mutations,” “KCNJ5,” “organ damage,” “cardiovascular,” “diastolic function,” “metabolic syndrome,” “autonomous cortisol secretion,” etc.ResultsAPA patients with KCNJ5 somatic mutations are generally younger, female, have higher aldosterone levels, lower potassium levels, larger tumor size, and higher hypertension cure rate after adrenalectomy. This review focuses on the cardiovascular and metabolic aspects of KCNJ5 somatic mutations in APA patients, including left ventricular remodeling and diastolic function, abdominal aortic thickness and calcification, arterial stiffness, metabolic syndrome, abdominal adipose tissue, and correlation with autonomous cortisol secretion. Furthermore, we discuss modalities to differentiate the types of mutations before surgery.ConclusionKCNJ5 somatic mutations in patients with APA had higher left ventricular mass (LVM), more impaired diastolic function, thicker aortic wall, lower incidence of metabolic syndrome, and possibly a lower incidence of concurrent autonomous cortisol secretion, but better improvement in LVM, diastolic function, arterial stiffness, and aortic wall thickness after adrenalectomy compared to patients without KCNJ5 mutations.

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Cardiovascular outcomes and all-cause mortality in primary aldosteronism after adrenalectomy or mineralocorticoid receptor antagonist treatment: a meta-analysis

Cited by 24 publications

References 48 publications

Surgery for Primary Aldosteronism in France from 2010 to 2020, Results from the French-Speaking Association of Endocrine Surgery (AFCE) - Eurocrine® Study Group

Surgery for Primary Aldosteronism in France from 2010 to 2020, Results from the French-Speaking Association of Endocrine Surgery (AFCE) - Eurocrine® Study Group

Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study

Cardiovascular and metabolic characters of KCNJ5 somatic mutations in primary aldosteronism

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