Tuesday, 12 August 2025

Araujo-Castro M, Paja M, González M, Pascual E, Parra P, Rojas PM, García A,...Hanzu FA. Influence of smoking on cardiometabolic profile and surgical outcomes in patients with primary aldosteronism: a cohort study

Eur J Endocrinol. 2024

"The increased risk of left ventricular hypertrophy associated with primary aldosteronism is doubled and more severe in active smokers." -Dr. Marta Araujo-Castro

Summary:

Aim: To evaluate the influence of smoking on cardiometabolic profile and surgical outcomes in patients with primary aldosteronism (PA).

Methods: Multicentre retrospective study of patients with PA evaluated in 36 Spanish tertiary hospitals with available information on smoking habits [smokers and non-smokers (never smokers and ex-smokers)].

Results: A total of 881 patients were included, of whom 180 (20.4%) were classified as smokers and 701 as non-smokers. At diagnosis, smokers and non-smokers did not differ in blood pressure or serum potassium levels between. However, smokers had a higher prevalence of left ventricular hypertrophy (LVH) than non-smokers [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.23-3.25], and smokers were more likely to have severe LVH than non-smokers (12.5% vs 6.6%, P = .164). A larger mean tumour size of the adrenal nodule/s was observed in the smoking group (18.6 ± 9.66 vs 15.8 ± 8.66 mm, P = .002). In addition, the odds of mild autonomous cortisol secretion (MACS) was greater in smokers than in non-smokers (OR 2.1, 95% CI 1.14-4.06), but these differences disappeared when adjusted for the size of the adrenal nodule/s (adjusted OR 1.6, 95% CI 0.76-3.37). The rate of biochemical and hypertension cure was similar in both groups; however, hypertension cure tended to be more frequent in the non-smoker group (41.2% vs 29.9%, P = .076).

Conclusions: Patients with PA who smoke have a higher prevalence of LVH and MACS and larger adrenal nodule/s than non-smokers. Smoking has no significant effect on the probability of hypertension response after adrenalectomy in patients with PA; however, a tendency to a lower probability of hypertension cure is observed in smokers compared to non-smokers.

Why do you highlight this publication?

I belive that this publication is of great importance in the field of Endocrinology, Nephrology, Cardiology and Internal Medicine as it is the first study focused on evaluating the influence of smoking on cardiometabolic profile and surgical outcomes in patients with primary aldosteronism (PA). It is well-known that PA is the most common cause of secondary hypertension and is associated with a higher cardiometabolic risk and mortality compared to patients with essential hypertension, even when matched by age, sex and the same degree of hypertension. On the other hand, smoking is one of the major risk factors for malignancy and cardiovascular disease. However, the impact of smoking on the severity, cardiometabolic profile, and/or on the surgical outcomes in patients with PA has not been previously reported. Considering this background, we evaluated these outcomes in a large cohort of 881 patients with PA from the Spanish multicenter study (SPAIN-ALDO register). As the main findings, we found that smokers had a higher prevalence of left ventricular hypertrophy than non-smokers. In addition, adrenal nodules were larger and the prevalence of mild autonomous cortisol secretion were higher in smokers than in nonsmokers. In relation with surgical outcomes, we observed that hypertension cure tended to be 1.4 times more frequent in the non-smoker group (but statistical significance was not demonstrated). Our research demonstrated the negative impact of smoking in both the cardiometabolic profile and surgical outcomes of patients with PA. Therefore, it is crucial to educate patients with PA about the importance of quitting smoking and inform them about the negative impact of smoking on their clinical condition.