{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T20:53:36Z","timestamp":1793566416136,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:00:00Z","timestamp":1669075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In patients with primary aldosteronism (PA), long-term cardiovascular and mortality outcomes after adrenalectomy vs mineralocorticoid receptor antagonist (MRA) have not been compared yet. We aim to compare the clinical outcomes of these patients after treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis was conducted by searching PubMed, Cochrane library, and Embase from no start date restriction to 18 December 2021. Our composite primary outcomes were long-term all-cause mortality and\/or major adverse cardiovascular events (MACE), including coronary artery disease (CAD), stroke, arrhythmia, and congestive heart failure. We adopted the random-effects model and performed subgroup analyses, meta-regression, and trial sequential analysis (TSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 9 studies with 8473 adult patients with PA (\u226518 years) were enrolled. A lower incidence of composite primary outcomes was observed in the adrenalectomy group (odds ratio (OR): 0.46 (95% CI: 0.38\u20130.56), P &amp;lt; 0.001). We found a lower incidence of all-cause mortality (OR: 0.33 (95% CI: 0.15\u20130.73), P\u2009=\u20090.006) and MACE (OR: 0.55, (95% CI: 0.40\u20130.74), P\u2009=\u20090.0001) in the adrenalectomy group. The incidence of CAD (OR: 0.33 (95% CI: 0.15\u20130.75), P\u2009=\u20090.008), arrhythmias (OR: 0.46 (95% CI: 0.27\u20130.81), P\u2009=\u20090.007), and congestive heart failure (OR: 0.52 (95% CI: 0.33\u20130.81), P\u2009=\u20090.004) was also lower in adrenalectomy group. The metaregression showed patient's age may attenuate the benefits of adrenalectomy on composite primary outcomes (coefficient: 1.084 (95% CI: 1.005\u20131.169), P\u2009=\u20090.036). TSA demonstrated that the accrued sample size and effect size were sufficiently large to draw a solid conclusion, and the advantage of adrenalectomy over MRA was constant with the chronological sequence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, adrenalectomy could be preferred over MRA for patients with PA in reducing the risk of all-cause mortality and\/or MACE and should be considered as the treatment of choice. That patients with PA could get less benefit from adrenalectomy as they age warrants further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/eje-22-0375","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T13:17:16Z","timestamp":1667222236000},"page":"S47-S58","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-7","source":"Crossref","is-referenced-by-count":69,"title":["Cardiovascular outcomes and all-cause mortality in primary aldosteronism after adrenalectomy or mineralocorticoid receptor antagonist treatment: a meta-analysis"],"prefix":"10.1093","volume":"187","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-8277","authenticated-orcid":false,"given":"Sheng-Yin","family":"Chen","sequence":"first","affiliation":[{"name":"School of Medicine, Chang Gung University , Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui-Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center , Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chieh","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital , Taipei, Taiwan"},{"name":"School of Medicine, National Yang-Ming University , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-5836","authenticated-orcid":false,"given":"Troy Hai Kiat","family":"Puar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Chin Kek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital , Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff S","family":"Chueh","sequence":"additional","affiliation":[{"name":"Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University , Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8153-1441","authenticated-orcid":false,"given":"Yen-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Taiwan University Hospital , Taipei, Taiwan"},{"name":"TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group , 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