Is Primary Hyperaldosteronism a Risk Factor for Aortic Dissection?

Ahmed, S. Hinan; Husain, N.; Khawaja, S.; Massey, Clara V.; Pettyjohn, Frank S.

doi:10.1159/000095787

Cited by 15 publications

(12 citation statements)

References 13 publications

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“…However, aortic dissection has been demonstrated in patients with primary aldosteronism. 9 In addition, patients with glucocorticoid-remediable aldosteronism, an inherited form of primary hyperaldosteronism, often die at a young age due to rupture of cerebral aneurysms. 21 …”

Section: Discussionmentioning

confidence: 99%

“…In a clinical case report, aortic dissection was found in patients with primary aldosteronism (also known as hyperaldosteronism). 9 In addition, an analysis of drug modulation of AAA growth through 25 years of surveillance in 1,269 patients demonstrated a strong association between mineralocorticoid receptor blockers and slowed AAA progression. 10 However, a cause and effect relationship between the mineralocorticoid receptor and aortic aneurysms has not been tested.…”

Section: Introductionmentioning

confidence: 99%

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Mineralocorticoid Receptor Agonists Induce Mouse Aortic Aneurysm Formation and Rupture in the Presence of High Salt

Liu

Xie

Daugherty

et al. 2013

ATVB

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Objective Elevated plasma aldosterone concentrations in patients have been linked to a spectrum of cardiovascular diseases. Mineralocorticoid receptor antagonists provide additional benefits in heart failure patients. However, whether aldosterone and the mineralocorticoid receptor are involved in aortic aneurysm is unknown. Approach and Results We report that administration of deoxycorticosterone acetate (DOCA) and salt or aldosterone and salt, but not DOCA or salt alone, to C57BL/6 male mice induced abdominal and thoracic aortic aneurysm formation and rupture in an age-dependent manner. DOCA and salt or aldosterone and salt induced aortic aneurysm mimicked human aortic aneurysm with respect to elastin degradation, inflammatory cell infiltration, smooth muscle cell degeneration and apoptosis, and oxidative stress. Aortic aneurysm formation did not correlate with the increase in blood pressure induced by DOCA and salt. Systemic administration of the angiotensin converting enzyme inhibitor, enalapril, or angiotensin type 1 receptor antagonist, losartan, did not affect DOCA and salt induced aortic aneurysm. In contrast, the mineralocorticoid receptor antagonists, spironolactone or eplerenone, significantly attenuated DOCA and salt or aldosterone and salt induced aortic aneurysm. Conclusions The current study describes a novel aortic aneurysm animal model induced by mineralocorticoid receptor agonist and high salt, and reveals a previously unrecognized but potentially significant role of aldosterone in the pathogenesis of aortic aneurysm. These findings imply that mineralocorticoid receptor antagonists may be effective in the treatment of some aortic aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mineralocorticoid Receptor Agonists Induce Mouse Aortic Aneurysm Formation and Rupture in the Presence of High Salt

Liu

Xie

Daugherty

et al. 2013

ATVB

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“…Primary aldosteronism is a curable form of secondary hypertension, and the incidence of primary aldosteronism among hypertensives is higher than previously reported 5) . It has been reported that aldosterone plays a crucial role in the development of damaged organs following heart failure, fibrotic changes in blood vessels, and renal failure 7) , and that primary hyperaldosteronism is a potential independent risk factor for aortic dissection 8) . There are several reports of patients with primary aldosteronism, which caused dissecting aortic aneurysm 9,10) .…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone

Ito

Yoshimura

Matsuzawa

et al. 2010

JAT

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We describe a diabetic patient successfully treated for an acute mycotic aortic arch pseudoaneurysm with primary aldosteronism. The patient first complained of severe pain in the left upper extremity and left back with high C reactive protein (CRP) and high-grade fever. It was suspected that acute aortic dissection had developed in association with mycotic pseudoaneurysm of the aortic arch because of chest X-ray findings of enlargement of the aortic arch. Computed tomography (CT) of the aortic arch revealed an aortic aneurysm protruding in the superior direction. Staphylococcus aureus was detected in blood culture, suggesting a mycotic aortic aneurysm, and artificial blood vessel replacement of the aortic arch was performed. Intraoperative findings suggested aortic pseudoaneurysm, which consisted of mediastinal rupture of the aorta at the distal arch. Our patient had a 2-year history of type 2 diabetes mellitus and poor blood sugar control, even with twice-daily injection of insulin. Blood pressure was not always well controlled because of primary aldosteronism. Thus, it was speculated that hyperaldosteronism, as well as diabetes-associated atherosclerosis, had persisted for a long time. No reports have described mycotic pseudoaneurysm in the aortic arch in a diabetic patient associated with primary aldosteronism. It is necessary to note that serious vascular complications are possible if aldosteronism is left untreated or is treated insufficiently as essential hypertension. J Atheroscler Thromb, 2010; 17:771-775.

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“…Aldosterone may affect the matrix metalloproteinases and their inhibitors, leading to collagen degradation and subsequent medial necrosis [4]. Aldosterone may activate the adventitia, resulting in proliferation and migration of fibroblast and secretion of collagen to exacerbate vascular remodeling [11].…”

Section: Discussionmentioning

confidence: 99%