Arterial Stiffness Associated With Long-term Major Adverse Cardiac Events in Patients With Primary Aldosteronism

Context As a novel parameter for risk prediction, artery stiffness may hold promise in refining risk assessment strategies, guiding therapeutic interventions, and ultimately improving cardiovascular outcomes in patients with primary aldosteronism (PA). Objective and Methods To investigate the correlation between brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, and the occurrence of major adverse cardiovascular events (MACEs) in patients with PA under a primary prevention design. Results Among the 830 patients included in the final analysis, 113 (13.6%) developed incident MACEs over a median follow-up period of 5.8 years, with a crude rate of 23.2 per 1000 person-years. Multivariable Cox proportional hazards analyses revealed that baPWV was an independent risk factor for incident MACEs, with an adjusted hazard ratio (HR) of 1.01 (P = .028). The generalized additive model identified a cut-off value of 2000 cm/s for baPWV, which was independently associated with incident MACEs, with a HR of 1.81 (P = .024), while accounting for mortality as a competing risk. Subgroup analyses revealed that PA patients who were mineralocorticoid receptor antagonist users and had high baPWV had a significantly higher risk of incident MACEs (HR = 3.34; P < .001), whereas the risk was not significant in patients who underwent adrenalectomy (P = .062). Furthermore, the addition of baPWV to the cardiovascular Framingham risk score significantly improved the category-free net reclassification index (0.308, P < .001). Conclusions Our study found that 13.6% of patients with PA developed MACEs after a median follow-up of 5.8 years. Our findings highlight the potential utility of baPWV as a tool for risk stratification in patients with PA in primary prevention, whereas adrenalectomy appears to mitigate this risk regardless of baPWV. The measurement of baPWV could be a valuable addition to hypertension screening programs for primary prevention, providing additional predictive information for the potential occurrence of MACEs.