Eligibility for Statin Therapy According to New Cholesterol Guidelines on Primary Aldosteronism
Jui-Hsiang Lin1, Wei-Jie Wang1, Vin-Cent Wu2, and Kwan-Dun Wu2, and on behalf of the TAIPAI Study Group

Address all correspondence and requests for reprints to: Vin-Cent Wu, MD, PhD;
Department of Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei 100, Taiwan
, email: , phone: +886 2 23 123 456 × 63 098, and fax: +886 2 23 952 333.
DOI: http://dx.doi.org/10.1210/jc.2015-1537
Received: March 01, 2015
Accepted: March 18, 2015
Published Online: March 20, 2015
• ABSTRACT
• PDF
• SUPPL DATA
Abstract
Context:
The recommendation for statin therapy for the prevention of cardiovascular disease is expanded in the 2013 guidelines of the American College of Cardiology and the American Heart Association (ACC/AHA); nevertheless, the research focused on primary aldosteronism (PA) with high cardiovascular events in the different guidelines has not been documented.
Participants:
A total of 1197 patients with hypertension and received confirmatory tests were recorded from January 2007 to December 2013 in the Taiwan Primary Aldosteronism Investigation database.
Main Outcome Measures:
The relationship between every aldosterone level and different guidelines was analyzed with generalized additive model (GAM).
Results:
We enrolled 461 patients in the PA group (men, 44.9%; mean age, 57.4±8.4 years) and 553 control subjects as the essential hypertension (EH) group (men, 49.9%; mean age, 57.0±9.5 years). The PA patients had higher systolic blood pressures, higher LDL-c levels, and lower HDL-c levels compared to EH patients (p < 0.05). However, 10-year CV risk categories using 2013 ACC/AHA guidelines represented that estimated 10-year CV risk more than 7.5% (EH, 14.6%; PA, 16.5%; p < 0.001) was lower in EH than PA. Under ACC/AHA guidelines, the percentage of additional participants (43.8%) with EH recommended for statin therapy was lower than adults with PA (47.3%) (p < 0.01). Furthermore, GAM plot for the high levels of aldosterone tended to be more recommendations for lipid-lowering therapy in ACC/AHA guidelines than previous Adult Treatment Panel III guidelines, respectively.
Conclusions:
Elevated aldosterone levels are associated with intensive statin prescription in PA according to the ACC/AHA guidelines. Among the components of the metabolic syndrome, lower HDL-c and higher LDL-c were prevalent in PA patients. As compared with the EH group, the PA participants would consequently give higher proportion of statin therapy in ACC/AHA guidelines.