Arterial Stiffness Associated with Long-Term Major Adverse Cardiac Events in Patients of Primary Aldosteronism

Vin-Cent Wu; Wen-Kai Chu; Po-Lung Yang; Yen-Hung Lin; Shuo-Meng Wang; Jeff S Chueh

doi:10.1210/clinem/dgae683

Arterial Stiffness Associated with Long-Term Major Adverse Cardiac Events in Patients of Primary Aldosteronism

J Clin Endocrinol Metab. 2024 Oct 11:dgae683. doi: 10.1210/clinem/dgae683. Online ahead of print.

Authors

Vin-Cent Wu^{1

2

3}, Wen-Kai Chu¹, Po-Lung Yang¹, Yen-Hung Lin^{1

2

3}, Shuo-Meng Wang⁴, Jeff S Chueh^{3

4}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan.
² Primary Aldosteronism Center of National Taiwan University Hospital, Taipei 100225, Taiwan.
³ TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taipei100225, Taiwan.
⁴ Department of Urology, College of Medicine, National Taiwan University, Taipei100225, Taiwan.

PMID: 39391904
DOI: 10.1210/clinem/dgae683

Abstract

Contex: As a novel parameter for risk prediction, artery stifiness may hold promise in refining risk assessment strategies, guiding therapeutic interventions, and ultimately improving cardiovascular outcomes in patients with primary aldosteronism (PA).

Objective and methods: To investigate the correlation between brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, and the occurrence of major adverse cardiovascular events (MACEs) in patients with PA under a primary prevention design.

Results: Among the 830 patients included in the final analysis, 113 (13.6%) developed inciden t MACEs over a median follow-up period of 5.8 years, with a crude rate of 23.2 per 1000 person-years. Multivariable Cox proportional hazards analyses revealed that baPWV was an independent risk factor for incident MACEs, with an adjusted hazard ratio of 1.01 (P = 0.028). The generalized additive model identified a cut-off value of 2000 cm/s for baPWV, which was independently associated with incident MACEs, with a hazard ratio of 1.72 (P = 0.045). Subgroup analyses revealed that PA patients who were mineralocorticoid receptor antagonist (MRA) users and had high baPWV had a significantly higher risk of incident MACEs (HR = 3.34; P < 0.001), while the risk was not significant in patients who underwent adrenalectomy (P = 0.062). Furthermore, the addition of baPWV to the cardiovascular Framingham risk score significantly improved the category-free net reclassification index (0.308, P < 0.001).

Conclusions: Our study found that 13.6% of patients with PA developed MACEs after a median follow-up of 5.8 years. Our findings highlight the potential utility of baPWV as a tool for risk stratification in PA patients in primary prevention, whereas adrenalectomy appears to mitigate this risk irrespective of baPWV. The measurement of baPWV could be a valuable addition to hypertension screening programs for primary prevention, providing additional predictive information for the potential occurrence of MACEs.

Keywords: MACEs; PWV; TAIPAI; arterial stiffness; primary aldosteronism.

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