AF in Primary Aldosteronism: What Treatment Strategies Could Lower Incidence?

Patients with primary aldosteronism (PA) who undergo adrenalectomy may have a lower incidence of atrial fibrillation (AF), according to new study findings. Patients with PA are known to have a higher prevalence of AF and other cardiovascular complications.

Researchers arrived at their conclusion following a Taiwanese nationwide longitudinal cohort‐based study that used data for patients with PA without history of AF (n = 2202) from 1997 to 2009. Data were obtained from Taiwan’s National Health Insurance Research Database. Patients with PA were matched via propensity score with controls who had essential hypertension (n = 8808). Mean follow-up lasted 4.4 years.

The primary outcome of the study was defined as new-onset AF (NOAF), and the secondary outcomes were defined as mortality, major cardiac and cardiac/cerebrovascular events, and a combined endpoint of NOAF and mortality.

Of the 2202 patients with PA, 534 had undergone adrenalectomy, and 1668 had been treated with 1668 mineralocorticoid receptor antagonist (MRA) therapy. The results of the study demonstrated that patients with PA who had undergone adrenalectomy also had a lower incidence of NOAF (adjusted hazard ratio [HR] 0.28) compared with controls. However, the researchers noted, patients with PA who had been treated with MRA therapy had a comparable NOAF risk (adjusted HR 1.20).

In addition, patients with PA who had undergone adrenalectomy were found to have a lower rate of mortality and combined end point of NOAF and mortality compared with controls. Among patients with PA who received MRA therapy, higher risks of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality were observed compared with controls.

“Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF,” the researchers concluded. “However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy,” they wrote.

—Christina Vogt

Reference:
Pan C, Liao CW, Tsai CH, et al; TAIPEI study group. Influence of different treatment strategies on new‐onset atrial fibrillation among patients with primary aldosteronism: a nationwide longitudinal cohort‐based study. J Am Heart Assoc. 2020;9(5). https://doi.org/10.1161/JAHA.119.013699.