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

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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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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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 47, 1719–1727 (2024). https://doi.org/10.1038/s41440-024-01648-0

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