Zhou Shiting, Liu Jing, Li Zhuo, Yang Mingfeng, Sha Ruohe, Yan Ruike, Wang Xinxin, Cao Yanli
Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China.
Department of Radiology, The First Affiliated Hospital of China Medical University, 110001, Shenyang, China.
Hypertens Res. 2024 Jun;47(6):1719-1727. doi: 10.1038/s41440-024-01648-0. Epub 2024 Apr 2.
Recent studies have explored the association between primary aldosteronism and cardiovascular disease incidence. The association between specific primary aldosteronism treatments and differential improvement in cardiovascular event rates is yet to be established. This study was designed to compare the relative effects of spironolactone therapy and surgical intervention on cardiovascular outcomes among primary aldosteronism patients. This retrospective observational study included 853 primary aldosteronism patients from the First Affiliated Hospital of China Medical University between 2014 and 2022. Patients who had completed abdominal computed tomography (CT) examinations with similar metabolic characteristics and 6-month follow-up analyses were included in this study. These patients were separated into a surgical treatment group (n = 33) and a spironolactone treatment group (n = 51). Demographic data, biochemical analysis results, liver/spleen (L/S) X-ray attenuation ratio, hospitalization frequency, and cardiovascular events were compared between the two groups. The spironolactone group demonstrated significantly improved metabolic characteristics compared to the surgical group, shown by lower BMI, blood pressure, total cholesterol (TC), insulin resistance index (IRI), and reduced non-alcoholic fatty liver disease prevalence. Metabolic parameters did not differ significantly within the surgical treatment group when comparing pre- and postoperative values. The incidence of cardiovascular events was lower in the spironolactone group compared to the surgery group (23/33 vs. 20/51, P < 0.001) despite higher hospitalization rates(37/31 vs. 61/53, P < 0.001). In patients with primary aldosteronism, spironolactone treatment is more effective than surgical intervention in remediating abnormal lipid and glucose metabolism while improving cardiovascular outcomes. Chinese clinical trial registry registration number: ChiCTR2300074574.
近期研究探讨了原发性醛固酮增多症与心血管疾病发病率之间的关联。特定原发性醛固酮增多症治疗方法与心血管事件发生率的差异改善之间的关联尚未确立。本研究旨在比较螺内酯治疗和手术干预对原发性醛固酮增多症患者心血管结局的相对影响。这项回顾性观察性研究纳入了2014年至2022年间中国医科大学附属第一医院的853例原发性醛固酮增多症患者。本研究纳入了完成腹部计算机断层扫描（CT）检查且具有相似代谢特征并进行了6个月随访分析的患者。这些患者被分为手术治疗组（n = 33）和螺内酯治疗组（n = 51）。比较了两组之间的人口统计学数据、生化分析结果、肝/脾（L/S）X线衰减率、住院频率和心血管事件。与手术组相比，螺内酯组的代谢特征有显著改善，表现为较低体重指数、血压、总胆固醇（TC）、胰岛素抵抗指数（IRI）以及非酒精性脂肪肝病患病率降低。手术治疗组术前和术后的代谢参数无显著差异。尽管螺内酯组住院率较高（37/31 vs. 61/53，P < 0.001），但其心血管事件发生率低于手术组（23/33 vs. 20/51，P < 0.001）。对于原发性醛固酮增多症患者，螺内酯治疗在纠正脂质和葡萄糖代谢异常以及改善心血管结局方面比手术干预更有效。中国临床试验注册登记号：ChiCTR2300074574。
