Primary aldosteronism in premature coronary artery disease: A cross-sectional study from a tertiary center in India

BACKGROUND: Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension and is associated with adverse cardiovascular outcomes. While its prevalence is well established among patients with resistant hypertension and hypokalemia, evidence regarding its occurrence in premature coronary artery disease (CAD) remains limited, particularly in South Asian populations with a high burden of early cardiovascular disease. OBJECTIVE: To determine the prevalence of PA in patients with premature CAD (≤45 years) and to describe their clinical and biochemical characteristics. METHODS: In this prospective observational study, 64 patients with premature CAD and 60 age-matched controls with CAD onset after 45 years were evaluated. Patients with a positive screening result-defined as plasma direct renin concentration (DRC) < 12 μIU/mL together with plasma aldosterone concentration (PAC) > 10 ng/dL-underwent a recumbent saline infusion test (SIT). A post-infusion PAC >5 ng/dL was considered confirmatory for the diagnosis of primary aldosteronism. Clinical, biochemical and cardiovascular parameters were systematically assessed. RESULTS: Among 64 patients with premature CAD, 2 (3.1%) were diagnosed with PA, whereas no cases were identified in the control group. PA-positive patients exhibited significantly higher systolic (161 ± 15.6 mmHg) and diastolic (94.0 ± 5.7 mmHg) blood pressures, longer hypertension duration, and echocardiographic evidence of left ventricular hypertrophy compared with PA-negative patients. CONCLUSION: PA may represent an underrecognized contributor to premature CAD in young adults. Larger multicenter studies are needed to validate these observations. Routine PA screening in young CAD patients could enable earlier diagnosis and targeted management, potentially reducing long-term cardiovascular morbidity.