Lin Jui-Hsiang, Lin Yu-Feng, Wang Wei-Jie, Lin Yuh-Feng, Chueh Shih-Chieh Jeff, Wu Vin-Cent, Chu Tzong-Shinn, Wu Kwan-Dun
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Division of Nephrology and Sinwu Branch, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan.
J Clin Med. 2018 Oct 24;7(11):382. doi: 10.3390/jcm7110382.
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.
美国心脏病学会（ACC）和美国心脏协会（AHA）推荐使用他汀类药物治疗来预防动脉粥样硬化性心血管疾病（ASCVD）；然而，其在原发性醛固酮增多症（PA）患者中的有效性尚未见报道。我们根据ACC/AHA指南，调查了PA中年患者与原发性高血压（EH）患者相比发生ASCVD的风险。我们纳入了461例PA患者和553例EH患者。尽管每组中代谢综合征的比例相似，但与EH组相比PA组的收缩压更高、低密度脂蛋白水平更高、血浆醛固酮浓度（PAC）更高、高密度脂蛋白水平更低以及10年ASCVD风险更高。在PA组中，根据ACC/AHA指南推荐使用他汀类药物来预测ASCVD的判别能力是合适的（即受试者工作特征曲线下面积（95%置信区间；0.94（0.91⁻0.96））。广义相加模型显示，PAC高于60 ng/dL的患者符合ACC/AHA建议的他汀类药物使用标准时机。ACC/AHA指南在预测中年高危高血压患者方面具有良好的判别能力，而PAC可识别出可能从早期他汀类药物治疗中获益 的高危个体。
