Abstract
The use of statin therapy on the prevention of atherosclerotic cardiovascular disease (ASCVD) is recommended by the American College of Cardiology (ACC) and the American Heart Association (AHA); nevertheless, its validation on primary aldosteronism (PA) patients has not been reported. We investigated the risk of incident ASCVD in middle-aged patients with PA compared with essential hypertension (EH) based on ACC/AHA recommendations. We enrolled 461 PA patients and 553 EH patients. Even though the ratio of metabolic syndrome in each group was similar, the PA group had higher systolic blood pressures, higher low-density lipoprotein levels, higher plasma aldosterone concentration (PAC), lower high-density lipoprotein levels, and higher 10-year ASCVD compared to the EH group. The discriminative power for predicting ASCVD by the recommended statin use from the ACC/AHA guidelines was proper in the PA group (i.e., under the receiver operating characteristic curve (95% confidence interval; 0.94 (0.91–0.96)). The generalized additive model showed patients with PAC higher than 60 ng/dL accompanying the standard timing of the statin use suggested by the ACC/AHA. The ACC/AHA guidelines have good discriminative power in the prediction of middle-aged high-risk hypertensive patients, while PAC identifies those high-risk individuals who may benefit from early statin therapy.
Highlights
Primary aldosteronism (PA), characterized by the autonomous production of aldosterone, is a common and potentially curable disease of secondary hypertension [1,2]
We studied the relationship of plasma aldosterone concentration (PAC) and the use of statins based on the suggestion of the guidelines for the prevention of atherosclerotic cardiovascular disease (ASCVD)
Our study indicated that the estimated ASCVD risk and the recommended statin use according to the algorithm by the American College of Cardiology (ACC)/American Heart Association (AHA) had good discriminative power in the ratio of 10-year ASCVD in both PA and essential hypertension (EH) patients
Summary
Primary aldosteronism (PA), characterized by the autonomous production of aldosterone, is a common and potentially curable disease of secondary hypertension [1,2]. The ACC/AHA guidelines introduced a prediction model and lowered the threshold for treatment with statins to a 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5%. The ACC/AHA guidelines for the management of cholesterol increase the number of adults who would be eligible for statin therapy [8] and have better predictive value for cardiovascular (CV) events [9] compared with the previous Adult Treatment Panel III (ATP-III) guidelines [2]. Based on a Cardiovascular Life Expectancy Model to estimate the advantages of risk factor modification in the prevention of CV events, forecasting advantages of using statin for the therapy of hyperlipidemia have shown that middle-aged patients have the highest level of benefits [10]. The implications of this updated guideline for statin recommendations have not been addressed in a population at high risk for a CV event, mainly primary aldosteronism patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
