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The effect of different treatment strategies on glycolipid metabolism disorders and cardiovascular events in primary aldosteronism

Hypertension Research (2024)Cite this article

Abstract

Recent studies have explored the association between primary aldosteronism and cardiovascular disease incidence. The association between specific primary aldosteronism treatments and differential improvement in cardiovascular event rates is yet to be established. This study was designed to compare the relative effects of spironolactone therapy and surgical intervention on cardiovascular outcomes among primary aldosteronism patients. This retrospective observational study included 853 primary aldosteronism patients from the First Affiliated Hospital of China Medical University between 2014 and 2022. Patients who had completed abdominal computed tomography (CT) examinations with similar metabolic characteristics and 6-month follow-up analyses were included in this study. These patients were separated into a surgical treatment group (n = 33) and a spironolactone treatment group (n = 51). Demographic data, biochemical analysis results, liver/spleen (L/S) X-ray attenuation ratio, hospitalization frequency, and cardiovascular events were compared between the two groups. The spironolactone group demonstrated significantly improved metabolic characteristics compared to the surgical group, shown by lower BMI, blood pressure, total cholesterol (TC), insulin resistance index (IRI), and reduced non-alcoholic fatty liver disease prevalence. Metabolic parameters did not differ significantly within the surgical treatment group when comparing pre- and postoperative values. The incidence of cardiovascular events was lower in the spironolactone group compared to the surgery group (23/33 vs. 20/51, P < 0.001) despite higher hospitalization rates(37/31 vs. 61/53, P < 0.001). In patients with primary aldosteronism, spironolactone treatment is more effective than surgical intervention in remediating abnormal lipid and glucose metabolism while improving cardiovascular outcomes. Chinese clinical trial registry registration number: ChiCTR2300074574.

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References

  1. Reincke M, Bancos I, Mulatero P, Scholl UI, Stowasser M, Williams TA. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021;9:876–92.

    Article  PubMed  Google Scholar 

  2. Paschos P, Tziomalos K. Nonalcoholic fatty liver disease and the renin-angiotensin system: implications for treatment. World J Hepatol. 2012;4:327–31.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Luther JM, Luo P, Kreger MT, Brissova M, Dai C, Whitfield TT, et al. Aldosterone decreases glucose-stimulated insulin secretion in vivo in mice and in murine islets. Diabetologia. 2011;54:2152–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Shibayama Y, Wada N, Baba S, Obara S, Sakai H, Usubuchi H, et al. The risk factors for hepatic steatosis in patients with primary aldosteronism. Endocr J. 2020;67:623–9.

    Article  CAS  PubMed  Google Scholar 

  5. Wu VC, Chueh SJ, Chen L, Chang CH, Hu YH, Lin YH, et al. Risk of new-onset diabetes mellitus in primary aldosteronism: a population study over 5 years. J Hypertens. 2017;35:1698–708.

    Article  CAS  PubMed  Google Scholar 

  6. Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension. 2018;71:585–91.

    Article  CAS  PubMed  Google Scholar 

  7. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51–59.

    Article  PubMed  Google Scholar 

  8. Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med. 2008;168:80–5.

    Article  CAS  PubMed  Google Scholar 

  9. Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, et al. Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension. 2012;60:618–24.

    Article  CAS  PubMed  Google Scholar 

  10. Plouin PF, Amar L, Chatellier G. Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension. Nephrol Dial Transplant. 2004;19:774–7.

    Article  PubMed  Google Scholar 

  11. Chen Y, Chen X, Chen Q, Yu C. Non-alcoholic fatty liver disease and hypokalemia in primary aldosteronism among Chinese population. Front Endocrinol (Lausanne). 2021;12:565714.

    Article  PubMed  Google Scholar 

  12. Wang J, Ma L, Chen S, Xu L, Miao M, Yu C, et al. Risk for the development of non-alcoholic fatty liver disease: a prospective study. J Gastroenterol Hepatol. 2018;33:1518–23.

    Article  CAS  PubMed  Google Scholar 

  13. Fallo F, Dalla Pozza A, Tecchio M, Tona F, Sonino N, Ermani M, et al. Nonalcoholic fatty liver disease in primary aldosteronism: a pilot study. Am J Hypertens. 2010;23:2–5.

    Article  CAS  PubMed  Google Scholar 

  14. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889–916.

    Article  CAS  PubMed  Google Scholar 

  15. Wang K, Hu J, Yang J, Song Y, Fuller PJ, Hashimura H, et al. Development and validation of criteria for sparing confirmatory tests in diagnosing primary aldosteronism. J Clin Endocrinol Metab. 2020;105:2449–56.

    Article  Google Scholar 

  16. Hung A, Ahmed S, Gupta A, Davis A, Kline GA, Leung AA, et al. Performance of the aldosterone to renin ratio as a screening test for primary aldosteronism. J Clin Endocrinol Metab. 2021;106:2423–35.

    Article  PubMed  Google Scholar 

  17. Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5:689–99.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Xu C, Chen Y, Xu L, Miao M, Li Y, Yu C. Serum complement C3 levels are associated with nonalcoholic fatty liver disease independently of metabolic features in Chinese population. Sci Rep. 2016;6:23279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lewandowski KC, Skowronska-Jozwiak E, Lukasiak K, Galuszko K, Dukowicz A, Cedro M, et al. How much insulin resistance in polycystic ovary syndrome? Comparison of HOMA-IR and insulin resistance (Belfiore) index models. Arch Med Sci. 2019;15:613–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156:1264–1281.e4.

    Article  PubMed  Google Scholar 

  21. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45:1243–8.

    Article  CAS  PubMed  Google Scholar 

  22. Zennaro MC, Boulkroun S, Fernandes-Rosa FL. Pathogenesis and treatment of primary aldosteronism. Nat Rev Endocrinol. 2020;16:578–89.

    Article  CAS  PubMed  Google Scholar 

  23. Son DH, Lee HS, Lee YJ, Lee JH, Han JH. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome. Nutr Metab Cardiovasc Dis. 2022;32:596–604.

    Article  CAS  PubMed  Google Scholar 

  24. Adler GK, Murray GR, Turcu AF, Nian H, Yu C, Solorzano CC, et al. Primary aldosteronism decreases insulin secretion and increases insulin clearance in humans. Hypertension. 2020;75:1251–9.

    Article  CAS  PubMed  Google Scholar 

  25. Ipsen DH, Lykkesfeldt J, Tveden-Nyborg P. Molecular mechanisms of hepatic lipid accumulation in non-alcoholic fatty liver disease. Cell Mol Life Sci. 2018;75:3313–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Tetti M, Gong S, Veglio F, Reincke M, Williams TA. Primary aldosteronism: Pathophysiological mechanisms of cell death and proliferation. Front Endocrinol (Lausanne). 2022;13:934326.

    Article  PubMed  PubMed Central  Google Scholar 

  27. van der Heijden C, Bode M, Riksen NP, Wenzel UO. The role of the mineralocorticoid receptor in immune cells in cardiovascular disease. Br J Pharmacol. 2022;179:3135–51.

    Article  PubMed  Google Scholar 

  28. Hosoya K, Minakuchi H, Wakino S, Fujimura K, Hasegawa K, Komatsu M, et al. Insulin resistance in chronic kidney disease is ameliorated by spironolactone in rats and humans. Kidney Int. 2015;87:749–60.

    Article  CAS  PubMed  Google Scholar 

  29. Mato JM, Alonso C, Noureddin M, Lu SC. Biomarkers and subtypes of deranged lipid metabolism in non-alcoholic fatty liver disease. World J Gastroenterol. 2019;25:3009–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Velema M, Dekkers T, Hermus A, Timmers H, Lenders J, Groenewoud H, et al. Quality of life in primary aldosteronism: a comparative effectiveness study of adrenalectomy and medical treatment. J Clin Endocrinol Metab. 2018;103:16–24.

    Article  PubMed  Google Scholar 

  31. Amar L, Plouin PF, Steichen O. Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism. Orphanet J Rare Dis. 2010;5:9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Katsiki N, Mikhailidis DP, Mantzoros CS. Non-alcoholic fatty liver disease and dyslipidemia: an update. Metabolism. 2016;65:1109–23.

    Article  CAS  PubMed  Google Scholar 

  33. Munoz-Durango N, Arrese M, Hernandez A, Jara E, Kalergis AM, Cabrera D. A mineralocorticoid receptor deficiency in myeloid cells reduces liver steatosis by impairing activation of CD8(+) T cells in a nonalcoholic steatohepatitis mouse model. Front Immunol. 2020;11:563434.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Alqarni I, Bassiouni YA, Badr AM, Ali RA. Telmisartan and/or chlorogenic acid attenuates fructose-induced non-alcoholic fatty liver disease in rats: Implications of cross-talk between angiotensin, the sphingosine kinase/sphingoine-1-phosphate pathway, and TLR4 receptors. Biochem Pharmacol. 2019;164:252–62.

    Article  CAS  PubMed  Google Scholar 

  35. Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383:2219–29.

    Article  CAS  PubMed  Google Scholar 

  36. Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: factors influencing risk, prediction and treatment. Diabetes Metab. 2021;47:101215.

    Article  CAS  PubMed  Google Scholar 

  37. Amar L, Lorthioir A, Azizi M, Plouin PF. Progress in primary aldosteronism. Mineralocorticoid antagonist treatment for aldosterone-producing adenoma. Eur J Endocrinol. 2015;172:R125–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The original data used in this article will be provided by the authors.

Funding

Liaoning Provincial Health Commission Xingliao Talents Program - Young Medical Master Project (YXMJ-QN-01).

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  1. These authors contributed equally: Shiting Zhou, Jing Liu

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China

    Shiting Zhou, Zhuo Li, Mingfeng Yang, Ruohe Sha, Ruike Yan, Xinxin Wang & Yanli Cao

  2. Department of Radiology, The First Affiliated Hospital of China Medical University, 110001, Shenyang, China

    Jing Liu

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Contributions

Professor Yanli Cao proposed the initial concept. Dr. Jing Liu collected clinical data. Dr. Zhuo Li, Mingfeng Yang, Ruohe Sha, Ruike Yan, and Xinxin Wang collected medical records, and Shiting Zhou designed the research protocol, collected demographic data, and conducted statistical analysis. Throughout the entire research process, Professor Yanli Cao provided supervision and consultation. All authors contributed to this article and approved the submitted version.

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Correspondence to Yanli Cao.

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This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of China Medical University.

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Zhou, S., Liu, J., Li, Z. et al. The effect of different treatment strategies on glycolipid metabolism disorders and cardiovascular events in primary aldosteronism. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01648-0

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