title: Cardiovascular risk markers in patients with primary aldosteronism: A systematic review and meta-analysis of literature studies.
abstract: OBJECTIVE
  Several 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.
  
  
  METHODS
  Studies 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.
  
  
  RESULTS
  12 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.
  
  
  CONCLUSIONS
  PA 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.
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lupoli
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Tortora
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Cacciapuoti
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Gelsy Arianna
authors.initials: GA
authors.lastname: Lupoli
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarantino
authors.affiliation: Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Nasto
authors.affiliation: Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy; Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: dario.diminno@hotmail.it.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
mesh_terms: D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D016022:Case-Control Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Arterial stiffness; Flow-mediated dilation; Intima-media thickness; Primary aldosteronism; Pulse-wave velocity; Subclinical atherosclerosis