Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis.
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ABSTRACT: Objectives
To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA).Methods
We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients with treated essential hypertension (EH). Primary endpoints were CVD incidence and all-cause mortality.Results
Compared with EH, patients with treated PA had a higher risk of CVD [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.39-2.31]. This elevated risk was only observed in patients with medically treated PA [OR 2.11; 95%CI 1.88-2.38] but not in those with surgically treated PA. The risk of all-cause mortality was significantly lower in patients with treated PA [OR 0.86; 95% CI 0.77-0.95] compared to EH. The reduced risk was only observed in patients with surgically treated PA [OR 0.47; 95% CI 0.34-0.66], but not in those with medically treated PA.Conclusions
Patients with medically treated PA have a higher risk of CVD compared to patients with EH. Surgical treatment of PA reduces the risk of CVD and all-cause mortality in patients with PA.
SUBMITTER: Jing Y
PROVIDER: S-EPMC8880484 | biostudies-literature | 2021 Jan-Dec
REPOSITORIES: biostudies-literature
Publications
Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis.
Jing Ying Y Liao Kangla K Li Ruolin R Yang Shumin S Song Ying Y He Wenwen W Wang Kanran K Yang Jun J Li Qifu Q Hu Jinbo J
Journal of the renin-angiotensin-aldosterone system : JRAAS 20210101 1
<h4>Objectives</h4>To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA).<h4>Methods</h4>We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients wit ...[more]
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Project description:Lifelong therapy with mineralocorticoid receptor antagonists (MRAs) or surgical adrenalectomy are the recommended treatments for primary aldosteronism (PA). Whether these treatments mitigate the risk for kidney disease remains unknown. We performed a retrospective cohort study of patients with PA treated with MRAs (N=400) or surgical adrenalectomy (N=120) and age- and estimated glomerular filtration rate-matched patients with essential hypertension (N=15 474) to determine risk for chronic kidney disease and longitudinal estimated glomerular filtration rate decline. Despite similar blood pressures, patients with PA treated with MRAs had a higher risk for incident chronic kidney disease compared with essential hypertension patients (adjusted hazard ratio, 1.63; 95% confidence interval, 1.33-1.99). Correspondingly, the adjusted annual decline in estimated glomerular filtration rate was greater in PA patients treated with MRAs compared with essential hypertension patients (-1.6; 95% confidence interval, -1.4 to -1.8 versus -0.9; 95% confidence interval, -0.9 to -1.0 mL/min per 1.73 m2/y; P<0.001). In contrast, patients with unilateral PA treated with surgical adrenalectomy had no significant difference in risk for incident chronic kidney disease or in an annual decline in estimated glomerular filtration rate compared with essential hypertension patients. Among PA patients with diabetes mellitus treated with MRAs, there was a higher risk for incident albuminuria compared with essential hypertension (adjusted hazard ratio, 2.52; 95% confidence interval, 1.28-4.96). MRA therapy in PA is associated with higher risk for developing chronic kidney disease when compared with essential hypertension, and surgical adrenalectomy may mitigate this risk. When possible, curative surgical adrenalectomy may be superior to lifelong MRA therapy in preventing kidney disease in PA.
| S-EPMC6202119 | biostudies-literature
Project description:ImportancePrimary aldosteronism (PA) is an ideal condition to evaluate the role of the mineralocorticoid receptor (MR) in the pathogenesis of atrial fibrillation (AF).ObjectiveTo investigate whether MR antagonist therapy or surgical adrenalectomy in PA influence the risk for incident AF.DesignThis cohort study included patients aged 18 years and older. Patients with PA and age-matched patients with essential hypertension were identified via electronic health records. Patients with a history of AF, myocardial infarction, congestive heart failure, or stroke were excluded. Data were collected between 1991 and the end of 2016 in an academic medical center, with a mean follow-up duration of approximately 8 years.ExposuresPatients with PA treated with MR antagonists or surgical adrenalectomy were compared with patients with essential hypertension. Patients with PA who were treated with MR antagonists were categorized by whether their plasma renin activity remained suppressed (< 1 ng/mL/h) or substantially increased (≥ 1 ng/mL/h), as proxies for insufficient or sufficient MR blockade.Main outcomes and measureIncident AF.ResultsA total of 195 patients with PA who were treated with MR antagonists and 201 patients with PA treated with surgical adrenalectomy were included, as well as 40 092 age-matched patients with essential hypertension. Despite similar blood pressure at study entry and throughout follow-up, patients with PA who were treated with MR antagonists whose renin remained suppressed had a higher risk for incident AF than patients with essential hypertension (adjusted HR, 2.55 [95% CI, 1.75-3.71]). They also had an adjusted 10-year cumulative AF incidence difference of 14.1 (95% CI, 6.7-21.5) excess cases per 100 persons compared with patients with essential hypertension. In contrast, patients with PA who were treated with MR antagonists and whose renin increased and patients with PA who were treated with surgical adrenalectomy had no statistically significant difference in risk for incident AF compared with patients with essential hypertension.Conclusions and relevanceWhen compared with patients with essential hypertension, patients with PA treated with MR antagonists such that renin remained suppressed (as a proxy for insufficient MR blockade) had a significantly higher risk for incident AF; however, treatment of PA with MR antagonists to substantially increase renin (suggesting sufficient MR blockade), or with surgical adrenalectomy (to remove the source of aldosteronism), was associated with no significant difference in risk for developing AF. These findings add to the growing body of evidence suggesting that MR blockade may be a potential therapy to decrease the incidence of AF.
| S-EPMC6143072 | biostudies-literature
Project description:BackgroundMineralocorticoid receptor (MR) antagonists are the recommended medical therapy for primary aldosteronism. Whether this recommendation effectively reduces cardiometabolic risk is not well understood. We aimed to investigate the risk of incident cardiovascular events in patients with primary aldosteronism treated with MR antagonists compared with patients with essential hypertension.MethodsWe did a cohort study using patients from a research registry from Brigham and Women's Hospital, Massachusetts General Hospital, and their affiliated partner hospitals. We identified patients with primary aldosteronism using International Classification of Disease, 9th and 10th Revision codes, who were assessed between the years 1991-2016 and were at least 18 years of age. We excluded patients who underwent surgical adrenalectomy, had a previous cardiovascular event, were not treated with MR antagonists, or had no follow-up visits after study entry. From the same registry, we identified a population with essential hypertension that was frequency matched by decade of age at study entry. We extracted patient cohort data and collated it into a de-identified database. The primary outcome was an incident cardiovascular event, defined as a composite of incident myocardial infarction or coronary revascularisation, hospital admission with congestive heart failure, or stroke, which was assessed using adjusted Cox regression models. Secondary outcomes were the individual components of the composite cardiovascular outcome, as well as incident atrial fibrillation, incident diabetes, and death.FindingsWe identified 602 eligible patients with primary aldosteronism treated with MR antagonists and 41 853 age-matched patients with essential hypertension from the registry. The two groups of patients had comparable cardiovascular risk profiles and blood pressure throughout the study. The incidence of cardiovascular events was higher in patients with primary aldosteronism on MR antagonists than in patients with essential hypertension (56·3 [95% CI 48·8-64·7] vs 26·6 [26·1-27·2] events per 1000 person-years, adjusted hazard ratio 1·91 [95% CI 1·63-2·25]; adjusted 10-year cumulative incidence difference 14·1 [95% CI 10·1-18·0] excess events per 100 people). Patients with primary aldosteronism also had higher adjusted risks for incident mortality (hazard ratio [HR] 1·34 [95% CI 1·06-1·71]), diabetes (1·26 [1·01-1·57]), and atrial fibrillation (1·93 [1·54-2·42]). Compared with essential hypertension, the excess risk for cardiovascular events and mortality was limited to patients with primary aldosteronism whose renin activity remained suppressed (<1 μg/L per h) on MR antagonists (adjusted HR [2·83 [95% CI 2·11-3·80], and 1·79 [1·14-2·80], respectively) whereas patients who were treated with higher MR antagonist doses and had unsuppressed renin (≥1 μg/L per h) had no significant excess risk.InterpretationThe current practice of MR antagonist therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension. Titration of MR antagonist therapy to raise renin might mitigate this excess risk.FundingUS National Institutes of Health.
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Project description:BackgroundLittle is reported about the role of medical management in the treatment of spinal arachnoid diverticula (SAD) in dogs.ObjectivesTo describe the outcome of 96 dogs treated medically or surgically for SAD.AnimalsNinety-six dogs with SAD.MethodsRetrospective case series. Medical records were searched for spinal arachnoid diverticula and all dogs with information on treatment were included. Outcome was assessed with a standardized questionnaire.ResultsFifty dogs were managed medically and 46 dogs were treated surgically. Dogs that underwent surgery were significantly younger than dogs that received medical management. No other variables, related to clinical presentation, were significantly different between both groups of dogs. The median follow-up time was 16 months (1-90 months) in the medically treated and 23 months (1-94 months) in the surgically treated group. Of the 38 dogs treated surgically with available long-term follow-up, 82% (n = 31) improved, 3% (n = 1) remained stable and 16% (n = 6) deteriorated after surgery. Of the 37 dogs treated medically with available long-term follow-up, 30% (n = 11) improved, 30% (n = 11) remained stable, and 40% (n = 15) deteriorated. Surgical treatment was more often associated with clinical improvement compared to medical management (P = .0002).Conclusions and clinical importanceThe results of this study suggest that surgical treatment might be superior to medical treatment in the management of SAD in dogs. Further studies with standardized patient care are warranted.
| S-EPMC5435043 | biostudies-literature
Project description:Surgically correctable forms of primary aldosteronism are characterized by unilateral aldosterone hypersecretion and renin suppression, associated with varying degrees of hypertension and hypokalemia. Unilateral aldosterone hypersecretion is caused by an aldosterone-producing adenoma (also known as Conn's adenoma and aldosteronoma), primary unilateral adrenal hyperplasia and rare cases of aldosterone-producing adrenocortical carcinoma. In these forms, unilateral adrenalectomy can cure aldosterone excess and hypokalemia, but not necessarily hypertension. The prevalence of primary aldosteronism in the general population is not known. Its prevalence in referred hypertensive populations is estimated to be between 6 and 13%, of which 1.5 to 5% have an aldosterone-producing adenoma or primary unilateral adrenal hyperplasia. Taking into account referral biases, the prevalence of surgically correctable primary aldosteronism is probably less than 1.5% in the hypertensive population and less than 0.3% in the general adult population. Surgically correctable primary aldosteronism is sought in patients with hypokalemic, severe or resistant forms of hypertension. Recent recommendations suggest screening for primary aldosteronism using the aldosterone to renin ratio. Patients with a raised ratio then undergo confirmatory suppression tests. The differential diagnosis of hypokalemic hypertension with low renin includes mineralocorticoid excess, with the mineralocorticoid being cortisol or 11-deoxycorticosterone, apparent mineralocorticoid excess, pseudo-hypermineralocorticoidism in Liddle syndrome or exposure to glycyrrhizic acid. Once the diagnosis is confirmed, adrenal computed tomography is performed for all patients. If surgery is considered, taking into consideration the clinical context and the desire of the patient, adrenal vein sampling is performed to detect whether or not aldosterone hypersecretion is unilateral. Laparoscopic surgery for unilateral aldosterone hypersecretion is associated with a morbidity of about 8%, with most complications being minor. It generally results in the normalization of aldosterone secretion and kalemia, and in a large decrease in blood pressure, but normotension without treatment is only achieved in half of all cases. Normotension following adrenalectomy is more frequent in young patients with recent hypertension than in patients with long-standing hypertension or a family history of hypertension.
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Project description:The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. The present meta-analysis was conducted to comprehensively analyze the available evidence on the consistency and strength of the association between the consumption of white meat, death from any cause and incidence of fatal and non-fatal cardiovascular (CV) events. PubMed, Web of Science, Scopus and Embase databases were searched for articles published up to April 30, 2020. We included prospective cohort studies reporting relative risks and pertinent 95% confidence intervals (CI) for all-cause mortality and/or CV events (fatal or non-fatal). A total of 22 studies were included in the meta-analysis. Eleven studies (14 data sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular disease (CVD) mortality and 10 studies (11 datasets) on non-fatal CV events. When comparing the highest versus the lowest consumption of white meat, the pooled OR and pertinent 95% CI were 0.94 (0.90, 0.97, p < 0.001) for all-cause mortality, 0.95 (0.89, 1.01, p = 0.13) for CV mortality, and 0.99 (0.95, 1.02, p = 0.48) for non-fatal CV events. In conclusion, the study shows for the first time a robust and inverse association between white meat consumption and all-cause mortality and a neutral association with CV mortality and morbidity. This highlights the importance of differentiating the meat types for what concerns their health effects and suggests that white meat might be a healthier alternative to read and processed meat consumption.
| S-EPMC7924043 | biostudies-literature
Project description:ImportanceOptimism and pessimism can be easily measured and are potentially modifiable mindsets that may be associated with cardiovascular risk and all-cause mortality.ObjectiveTo conduct a meta-analysis and systematic review of the association between optimism and risk for future cardiovascular events and all-cause mortality.Data sources and study selectionPubMed, Scopus, and PsycINFO electronic databases were systematically searched from inception through July 2, 2019, to identify all cohort studies investigating the association between optimism and pessimism and cardiovascular events and/or all-cause mortality by using the following Medical Subject Heading terms: optimism, optimistic explanatory style, pessimism, outcomes, endpoint, mortality, death, cardiovascular events, stroke, coronary artery disease, coronary heart disease, ischemic heart disease, and cardiovascular disease.Data extraction and synthesisData were screened and extracted independently by 2 investigators (A.R. and C.B.). Adjusted effect estimates were used, and pooled analysis was performed using the Hartung-Knapp-Sidik-Jonkman random-effects model. Sensitivity and subgroup analyses were performed to assess the robustness of the findings. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed.Main outcomes and measuresCardiovascular events included a composite of fatal cardiovascular mortality, nonfatal myocardial infarction, stroke, and/or new-onset angina. All-cause mortality was assessed as a separate outcome.ResultsThe search yielded 15 studies comprising 229 391 participants of which 10 studies reported data on cardiovascular events and 9 studies reported data on all-cause mortality. The mean follow-up period was 13.8 years (range, 2-40 years). On pooled analysis, optimism was significantly associated with a decreased risk of cardiovascular events (relative risk, 0.65; 95% CI, 0.51-0.78; P < .001), with high heterogeneity in the analysis (I2 = 87.4%). Similarly, optimism was significantly associated with a lower risk of all-cause mortality (relative risk, 0.86; 95% CI, 0.80-0.92; P < .001), with moderate heterogeneity (I2 = 73.2%). Subgroup analyses by methods for assessment, follow-up duration, sex, and adjustment for depression and other potential confounders yielded similar results.Conclusions and relevanceThe findings suggest that optimism is associated with a lower risk of cardiovascular events and all-cause mortality. Future studies should seek to better define the biobehavioral mechanisms underlying this association and evaluate the potential benefit of interventions designed to promote optimism or reduce pessimism.
| S-EPMC6777240 | biostudies-literature
Project description:We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88-0.94), 7% (RR 0.93, 95% CI: 0.84-1.03), and 10% (RR 0.90, 95% CI: 0.88-0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81-0.87), 17% (RR 0.83, 95% CI: 0.78-0.89), and 13% (RR 0.87, 95% CI: 0.84-0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87-0.92), 12% (RR 0.88, 95% CI: 0.82-0.94), and 9% (RR 0.91, 95% CI: 0.89-0.94). A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.
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Project description:BackgroundPostprandial hypotension (PPH) has been reported to be associated with syncope, falls, adverse cardiovascular outcomes, and increased all-cause mortality. It has been reported to have an incidence as high as 30% in the elderly and persons with diabetes. We therefore performed a meta-analysis to determine the relation of PPH with cardiovascular disease (CVD) events and all-cause mortality.ObjectivesOur objective was to conduct a systematic review and meta-analysis of cohort and cross-sectional studies to determine the association of PPH with CVD and all-cause mortality.MethodsWe searched the databases MEDLINE, EMBASE, and Cochrane library up to 13 April 2022 for prospective cohort and cross-sectional studies that examined the association of PPH with CVD outcomes and all-cause mortality. Data were analyzed using the generic inverse variance method with a random-effects model. Grading of Recommendations, Assessment, Development, and Evaluation approach assessed the certainty of evidence.ResultsSeven studies that included 2389 participants met our inclusion criteria. PPH was associated with each outcome individually, including increased all-cause mortality, total CVD, CVD mortality, and stroke. CVD outcomes and all-cause mortality combined were also associated with PPH (RR: 1.52; 95% CI: 1.05, 2.18; P = 0.03; I2 = 77%). The certainty of evidence was graded as very low due to significant heterogeneity and the limited number of studies.ConclusionsThis assessment indicates an association of PPH with CVD and all-cause mortality. Further studies are required to improve CVD and mortality estimates, but the potential seriousness of CVD and all-cause mortality as outcomes of PPH justifies more screening, diagnosis, and research.
| S-EPMC9437988 | biostudies-literature
Project description:BackgroundA goal of 10,000 steps per day is widely advocated, but there is little evidence to support that goal. Our purpose was to examine the dose-response relationships between step count and all-cause mortality and cardiovascular disease risk.MethodsCochrane Central Register of Controlled Trials, EMBASE, OVID, PubMed, Scopus, and Web of Science databases were systematically searched for studies published before July 9, 2021, that evaluated the association between daily steps and at least 1 outcome.ResultsSixteen publications (12 related to all-cause mortality, 5 related to cardiovascular disease; and 1 article contained 2 outcomes: both all-cause death and cardiovascular events) were eligible for inclusion in the meta-analysis. There was evidence of a nonlinear dose-response relationship between step count and risk of all-cause mortality or cardiovascular disease (p = 0.002 and p = 0.014 for nonlinearity, respectively). When we restricted the analyses to accelerometer-based studies, the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05% lower risk of cardiovascular event than the first quartile (all-cause mortality: Q1 = 4183 steps/day, Q3 = 8959 steps/day; cardiovascular event: Q1 = 3500 steps/day, Q3 = 9500 steps/day; respectively).ConclusionOur meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults, with nonlinear dose-response patterns.
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