Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies

Pasquale Ambrosino, Roberta Lupoli, Anna Tortora, Marianna Cacciapuoti, Gelsy Arianna Lupoli, Paolo Tarantino, Aurelio Nasto, Matteo Nicola Dario Di Minno

Research output: Contribution to journalArticle

Abstract

Background/objectives Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. Methods Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results 12 case-control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P <0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P <0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P <0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: - 2.52%; 95% CI: - 3.64, - 1.40; P <0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. Conclusions PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.

Original languageEnglish
Pages (from-to)46-55
Number of pages10
JournalInternational Journal of Cardiology
Volume208
DOIs
Publication statusPublished - Apr 1 2016

Fingerprint

Hyperaldosteronism
Meta-Analysis
Carotid Intima-Media Thickness
Pulse Wave Analysis
Common Carotid Artery
Dilatation
Ankle Brachial Index
PubMed
Nitrates
Habits
Case-Control Studies
Atherosclerosis
Heart Rate
Smoking
Databases
Morbidity
Mortality

Keywords

  • Arterial stiffness
  • Flow-mediated dilation
  • Intima-media thickness
  • Primary aldosteronism
  • Pulse-wave velocity
  • Subclinical atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiovascular risk markers in patients with primary aldosteronism : A systematic review and meta-analysis of literature studies. / Ambrosino, Pasquale; Lupoli, Roberta; Tortora, Anna; Cacciapuoti, Marianna; Lupoli, Gelsy Arianna; Tarantino, Paolo; Nasto, Aurelio; Di Minno, Matteo Nicola Dario.

In: International Journal of Cardiology, Vol. 208, 01.04.2016, p. 46-55.

Research output: Contribution to journalArticle

Ambrosino, Pasquale ; Lupoli, Roberta ; Tortora, Anna ; Cacciapuoti, Marianna ; Lupoli, Gelsy Arianna ; Tarantino, Paolo ; Nasto, Aurelio ; Di Minno, Matteo Nicola Dario. / Cardiovascular risk markers in patients with primary aldosteronism : A systematic review and meta-analysis of literature studies. In: International Journal of Cardiology. 2016 ; Vol. 208. pp. 46-55.
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abstract = "Background/objectives Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. Methods Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results 12 case-control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95{\%} CI: 0.09, 0.16; P <0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95{\%} CI: 0.90, 1.87; P <0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95{\%} CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95{\%} CI: 3.43, 4.05; P <0.00001), AIx@75 (MD: 8.59{\%}; 95{\%} CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: - 2.52{\%}; 95{\%} CI: - 3.64, - 1.40; P <0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. Conclusions PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.",
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AU - Lupoli, Roberta

AU - Tortora, Anna

AU - Cacciapuoti, Marianna

AU - Lupoli, Gelsy Arianna

AU - Tarantino, Paolo

AU - Nasto, Aurelio

AU - Di Minno, Matteo Nicola Dario

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N2 - Background/objectives Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk. Methods Studies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. Results 12 case-control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P <0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P <0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P <0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: - 2.52%; 95% CI: - 3.64, - 1.40; P <0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results. Conclusions PA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.

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