Associations Between Metabolic Profiles and Target-Organ Damage in Chinese Individuals With Primary Aldosteronism

Abstract

Purpose: Patients with primary aldosteronism (PA) have an increased risk of target-organ damage (TOD), but whether metabolic syndrome (MetS) is more prevalent and contributes to TOD in PA patients remains unresolved. We aimed to evaluate the associations between MetS profiles and TOD in Chinese PA individuals. Methods: Metabolic parameters and pre-clinical TOD including left ventricular hypertrophy, estimated glomerular filtration, and microalbuminuria; insulin sensitivity or resistance; and islet β-cell function were assessed by the homeostasis models (HOMA-IR, HOMA-β) and the other surrogate indexes [composite insulin sensitivity index (ISI), modified β-cell function index (MBCI)] determined from the oral glucose tolerance test were compared in PA vs. matched essential hypertension (EH) patients. Results: A total of 109 PA patients and 109 essential hypertension (EH) controls individually matched for sex, age, and office systolic blood pressure and duration of hypertension were studied. The prevalence of MetS and its individual components in PA was significantly lower than in EH [MetS: 28 (25.6%) vs. 54 (49.5%), P < 0.001]. PA patients had a higher composite ISI but a lower HOMA-IR, HOMA-β, and MBCI than EH controls (all P < 0.05). Concerning TOD, PA patients had significantly higher prevalence of microalbuminuria and left ventricular hypertrophy (LVH), and lower levels of estimated glomerular filtration (eGFR) than EH controls (all P < 0.05). On multivariate logistic regression analysis, female gender and elevated plasma aldosterone levels were significantly associated with TOD in PA. However, there were no significant associations between MetS and its individual components and TOD in PA patients. Conclusions: PA patients had a lower MetS prevalence but exhibited more severe TOD than matched EH controls. The study highlights the deleterious effects of aldosterone excess on the development of TOD, whereas MetS or its individual components might be less influential in PA.

Differences in Glycemic Abnormalities Between Primary Aldosteronism and Essential Hypertension: A Systematic Review and Meta-Analysis

“…One study did not provide data on sex ( 47 ). Nineteen studies were matched for demographic data ( 13 , 14 , 26 , 27 , 30 – 36 , 38 , 39 , 41 – 45 , 47 ). Regarding outcomes, 15 studies provided data on the prevalence of DM ( 2 , 13 , 14 , 27 – 29 , 31 , 32 , 34 , 35 , 37 – 39 , 47 , 48 ), 4 studies on IFG ( 2 , 14 , 35 , 40 ) and 5 studies on IGT ( 25 , 28 , 35 , 36 , 47 ).…”

“…Regarding outcomes, 15 studies provided data on the prevalence of DM ( 2 , 13 , 14 , 27 – 29 , 31 , 32 , 34 , 35 , 37 – 39 , 47 , 48 ), 4 studies on IFG ( 2 , 14 , 35 , 40 ) and 5 studies on IGT ( 25 , 28 , 35 , 36 , 47 ). Twenty studies included data on FBG ( 2 , 14 , 25 , 27 , 28 , 30 , 32 , 34 – 38 , 40 – 47 ) with 10 studies excluded DM patients or discontinuing hypoglycemic agents before recruitment ( 25 , 30 , 36 , 40 – 46 ), 7 on HbA1c ( 13 , 25 , 26 , 30 , 31 , 36 ), 5 on 2-hr OGTT ( 25 , 30 , 32 , 36 , 47 ), 10 on HOMA-IR ( 25 , 26 , 28 , 30 , 33 , 36 , 41 – 44 ), 5 on HOMA-ß ( 26 , 30 , 33 , 43 , 45 ), 3 on AUC of glucose ( 25 , 26 , 45 ), 4 on AUC of insulin ( 25 , 26 ...…”

“…Risk of bias was assessed using JBI tools for cohort, case-control and cross-sectional studies ( Table 1 ) . Most of the studies (22 of 27) evidenced high quality with a low risk of bias ( 2 , 13 , 14 , 26 – 28 , 30 – 33 , 35 , 36 , 38 – 44 , 46 – 48 ). The other five studies ( 25 , 29 , 34 , 37 , 45 ) showed moderate quality with a moderate risk of bias due to 1) important confounders not being identified and appropriately controlled for by proper statistical analyses for cross-sectional studies and 2) not being evaluated regarding the outcomes issues as measured outcomes were not relevant to the primary objectives of the current study for cohort studies.…”

The differences of serum lipid profiles between primary aldosteronism and essential hypertension: a meta-analysis and systematic review

“…Only one study excluded patients who used statins [ 10 ]. In one study, statins were withdrawn for 4 weeks prior to lipid profile evaluation [ 47 ], while five studies stated that statins were continued during the study [ 12 , 30 , 33 , 40 , 51 ]. The remaining studies did not mention this issue.…”

Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism

“…The structural renal damage induced by a high PAC in patients with PA may be associated with unfortunate outcomes, such as renal injury and renal failure (137,138). Patients with PA presented more frequently with microalbuminuria and albuminuria, lower eGFR, and increased creatinine levels (111,136,139,140). Studies have reported that albuminuria and renal failure were found in a range from 8 to 24% in subjects with PA (138,141).…”