Key result
Primary aldosteronism linked to ~23% higher all-cause mortality versus matched controls.
Why the study?
The extent to which increased mortality in primary aldosteronism is affected by sex, age, comorbidities at diagnosis, and different treatment modalities was largely unknown.
Does primary aldosteronism increase the risk of all-cause and cardiovascular mortality compared to matched controls from the general population?
Cohort (n=26,606)
Yes
Does primary aldosteronism increase the risk of all-cause and cardiovascular mortality compared to matched controls from the general population?
Patients with primary aldosteronism have a significantly higher risk of all-cause and cardiovascular mortality compared to the general population, with excess risk particularly notable in those who are older, have preexisting cardiovascular disease, or are inadequately treated.
Answers are grounded in this paper and cite their sources.
May warrant closer monitoring in primary aldosteronism; extends observational mortality data but leaves causal effects open.
BACKGROUND: Primary aldosteronism (PA) is associated with increased mortality. The extent to which this phenomenon is affected by sex, age, comorbidities at diagnosis, and different treatment modalities is largely unknown. The objective was to determine all-cause and cause-specific mortality in a population-based cohort of patients with PA and the impact of age at diagnosis, sex, comorbidities, and treatment modalities. METHODS: We used national registers to identify patients diagnosed with PA between 1997 and 2019 (n=2419) and controls (n=24 187) from the general population, matched for sex, age, and county of residence. We obtained mortality data from the Cause-of-Death Register. We used Cox regression models, adjusted for socioeconomic factors and diabetes, to estimate adjusted hazard ratios (HRs [95% CI]). RESULTS: Overall, 346 (14.3%) patients with PA and 2736 (11.3%) controls died during a median follow-up time of 8.1 years. PA was associated with increased risk from all-cause mortality (HR, 1.23 [95% CI, 1.10-1.38]), death from cardiovascular disease (HR, 1.57 [95% CI, 1.30-1.89]), and stroke (HR, 1.85 [95% CI, 1.16-2.93]). Patients with cardiovascular disease at diagnosis (HR, 1.53 [1.26-1.85]), age >56 years (HR, 1.28 [95% CI, 1.13-1.45]), patients treated with a low dose of a mineralocorticoid receptor antagonist (HR, 1.30 [95% CI, 1.02-1.66]), and untreated patients (HR, 2.51 [95% CI, 1.72-3.67]) had excess mortality. CONCLUSIONS: Mortality, mainly due to cardiovascular disease, is increased in patients with PA compared with controls from the general population, particularly in patients aged >56 years, patients with preexisting cardiovascular comorbidities, and patients receiving low dose of a mineralocorticoid receptor antagonist.
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Gkaniatsa et al. (2023) conducted a cohort in Primary aldosteronism (n=26,606). Primary aldosteronism vs. Controls from the general population was evaluated on All-cause mortality (HR 1.23, 95% CI 1.10-1.38). Primary aldosteronism was associated with an increased risk of all-cause mortality compared with matched controls (14.3% vs 11.3%; HR 1.23; 95% CI 1.10-1.38).
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