A-006 PRIMARY ALDOSTERONISM

Abstract

Background Althoughcystatin C is a stronger predictor of adverse cardiovascular events in a population with high cardiovascular burden, the clinical role of cystatin C in primaryaldosteronism is unknown, especially its association with endothelial function. Methods Patients with clinical suspicion of primary aldosteronism (PA) were consecutively referred to Taiwan Primary Aldosteronism Investigation (TAIPAI) group clinic for evaluation, and enrolled in this studybetween Feb, 2007 and July, 2010 after confirmation of diagnosis. A propensity score-matched, 2:1 ratio of patients with essential hypertension was selected for comparison. Cystatin C, pulse wave velocity, Framingham risk score and endothelial biomarkers, (endothelial progenitor cell (EPC), C-reactive protein (CRP), proteinuria) were estimated. Results A total of144 patients (59 male; age 50.3 ± 13.3 years) enrolled within the study period (111 with adenoma and 33 with hyperplasia), and 72 patients with essential hypertension matched as control. Patients with PA had significantly higher cystatin C, CRP and heavier proteinuria than the control group, while circulating endothelial progenitor cells were higher among control group. Multivariate linear regression analysis found that cystatinC is strongly predictive of proteinuria, pulse wave velocity and circulating EPC, CRP and 10-year Framingham risk score independent of other conventional risk factors in patients with PA. Conclusions Impaired endothelial function, assessed by using circulating biomarker levels and arterial stiffness has been observed in PA compared with referents with EH. Our study identifies that cystatin C is a potential biomarker in patients with PA, associated with various cardiovascular risk factors. It is endothelial dysfunction in PA patients explains increased CVD risk in this population, and mechanistic research to link PA with CVD should focus on inflammation, endothelial repairmen and arterial stiffness.