Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Alzheimers Res Ther. 2023 Aug 11;15(1):136. doi: 10.1186/s13195-023-01274-x.
Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH).
From the National Health Insurance Claim database in Korea (2003-2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches.
During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA.
The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia.
虽然高血压是痴呆的一个关键危险因素，但原发性醛固酮增多症（PA）与痴呆之间的关联鲜有报道。我们旨在研究与原发性高血压（EH）患者相比，PA 患者患痴呆的风险是否更高。
从韩国国家健康保险索赔数据库（2003-2017 年）中，我们按年龄和性别与 PA 患者（肾上腺切除术[ADX]，n=1339；醛固酮受体拮抗剂[MRA]，n=2348）以 1:4 的比例匹配无痴呆既往史的 3687 例患者（n=14741）。主要结局为所有原因的痴呆事件，包括阿尔茨海默病、血管性痴呆或其他痴呆合并一种或多种痴呆药物（多奈哌齐、加兰他敏、美金刚或利斯的明）的处方。使用多变量 Cox 回归模型评估 PA 患者与 EH 匹配患者之间结局发生率的风险比（HR）和 95%置信区间。
在中位随访 5.2 年期间，共有 156 例发生全因痴呆（4.2%）、140 例发生阿尔茨海默病（3.8%）和 65 例发生血管性痴呆（1.8%）。与 EH 相比，治疗后的 PA 患者发生全因痴呆的风险增加（未经调整的 HR 1.26；p<0.011）。在 PA 中，与 EH 相比，MRA 组全因痴呆（尤其是血管性痴呆）的风险更高，校正年龄、性别、收入、合并症和同时使用药物后（校正 HR 1.31；p=0.027 和校正 HR 1.62；p=0.020）。与 EH 相比，ADX 组似乎痴呆风险较低，但在充分调整后无统计学意义。当从 PA 诊断而非治疗开始评估痴呆风险时，这种趋势变得更加明显。
这项队列研究的结果表明，PA，特别是 MRA 组，与痴呆风险增加相关。即使在治疗开始后，也可能需要监测 PA 患者的认知功能，以预防痴呆。
