Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies

• Primary aldosteronism (PA) is associated with subclinical atherosclerosis.
• PA patients exhibit an increased carotid intima-media thickness (IMT).
• PA is associated with increased arterial stiffness and endothelial dysfunction.
• Specific cardiovascular prevention strategies are required in PA patients.

Background/objectivesSeveral studies reported an increased cardiovascular (CV) morbidity and mortality in patients with primary aldosteronism (PA). We performed a meta-analysis on the impact of PA on major markers of CV risk.MethodsStudies on the relationship between PA and common carotid artery intima-media thickness (CCA-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), pulse-wave velocity (PWV), augmentation index (AIx), and ankle-brachial index (ABI) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases.Results12 case–control studies (445 cases, 472 controls) were included. Compared to subjects with essential hypertension (EH), PA patients showed a higher CCA-IMT (MD: 0.12 mm; 95% CI: 0.09, 0.16; P < 0.00001), and a higher aortic-PWV (272 cases and 240 controls, MD: 1.39 m/s; 95% CI: 0.90, 1.87; P < 0.00001). In contrast, non-significant differences were found in AIx and AIx normalized to a heart rate of 75 beats per minute (AIx@75). When compared to normotensive subjects, PA patients showed significantly higher CCA-IMT (MD: 0.16 mm; 95% CI: 0.05, 0.27; P = 0.004), aortic-PWV (MD: 3.74 m/s; 95% CI: 3.43, 4.05; P < 0.00001), AIx@75 (MD: 8.59%; 95% CI: 0.69, 16.50; P = 0.03), and a significantly lower FMD (MD: − 2.52%; 95% CI: − 3.64, − 1.40; P < 0.0001). Sensitivity and subgroup analyses substantially confirmed our results. Metaregression models showed that male gender, diabetes, and smoking habit impact on the observed results.ConclusionsPA appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting.