Abstract P310: Subclinical primary aldosteronism is associated with an increased risk of major adverse cardiovascular events
Bibliographic record
Abstract
Background: Subclinical primary aldosteronism (PA), defined as renin-independent aldosterone production without overt PA, has recently been associated with adverse cardiac remodelling, unfavorable indices of arterial stiffness and incident hypertension. The objective of this study was to evaluate whether subclinical PA is linked to an increased risk of cardiovascular events. Methods: This study used data from CARTaGENE, a populational cohort of randomly selected individuals aged 40-69 years, with prospective outcomes data obtained from linkage with governmental administrative databases. The outcome of interest was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, stroke and heart failure, assessed from enrollment (2009-2010) to March 2021. All individuals with available plasma renin and aldosterone measurements, outcomes data and nutritional assessment were included in this study. Cox regression models were used to test the associated between MACE and the log-transformed aldosterone-to-renin ratio (ARR), with adjustments for sex, age, height, weight, race, diabetes, prior cardiovascular disease, smoking status, systolic BP, heart rate, estimated glomerular filtration rate, sodium and potassium levels, LDL- and total-cholesterol, antihypertensive drugs (listed as individual classes), statin and aspirin use, and 24-hour nutritional intake of sodium and potassium. Multiple imputation was used for missing data. Results: In 2,055 participants with available data (45.5% female, mean age 55.6 years, 6.6% diabetes, 2.9% prior cardiovascular disease, mean baseline systolic BP 128.5 mmHg), 58 MACEs occurred over a median follow-up of 10.8 years (IQR 10.6-11.0). In the Cox regression analysis, the log-transformed ARR was predictive of MACE with a hazard ratio (HR) of 2.86 (95% CI 1.34 to 6.10, p=0.007). Results were similar when participants taking any anti-hypertensive drug were excluded (HR 3.05, 95% CI 1.38 to 6.71, p=0.006). Conclusion: In a representative sample of the general population, a higher ARR appears to be highly predictive of adverse cardiovascular events. This indicates that subclinical PA could be an important and yet unrecognized risk factor for cardiovascular diseases, and may warrant screening in a broader population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".