SAT-456 Temporal Trends and Disparities in Ischemic Heart Disease-Related Mortality with Underlying Primary Adrenal Insufficiency: A 24-Year Analysis (1999-2022) using CDC-WONDER dataset

Abstract Disclosure: V. Gill: None. S. Soni: None. S. Govekar: None. C. Mullarkey-DeSapio: None. Introduction: Primary adrenal insufficiency (PAI) results from adrenal cortex destruction, leading to glucocorticoid and mineralocorticoid deficiencies that disrupt blood pressure regulation, electrolyte balance, and cardiovascular health. PAI is associated with increased cardiovascular morbidity and mortality. However, limited research exists on mortality trends in individuals with both PAI and cardiovascular diseases. This study evaluates 24-year temporal trends in PAI-related cardiovascular mortality, focusing on gender and racial disparities using CDC WONDER data. Methods: A retrospective analysis was conducted using CDC WONDER death certificate data (1999-2022) to examine ischemic heart disease (IHD)-related mortality associated with PAI (ICD-10 codes: IHD, I20-I25; PAI, E27.1). Variables analyzed included demographics (age, sex, race/ethnicity), urban-rural classification, place of death, region, and year. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. Census as the standard population. Temporal trends were assessed via Joinpoint regression, estimating annual percent changes (APCs), with p < 0.05 indicating statistical significance. Results: From 1999-2022, 9,855,626 IHD-related deaths were recorded (45.3% females). Among these, 1,092 deaths involved underlying PAI (57.9% females, 92% whites), predominantly in the 75+ age group and metropolitan areas. AAMRs for IHD-related deaths with PAI decreased from 0.028 in 1999 to 0.008 per 100,000 in 2022. Joinpoint analysis revealed decreasing trends from 1999-2005 (APC = -7.06) and 2005-2008 (APC = -28.74), followed by an increase from 2008-2011 (APC = 32.13) and a decline from 2011-2014 (APC = -27.17). A modest upward trend was observed after 2014 (APC = 6.25), with a 33% AAMR increase from 2021-2022. Subgroup analyses were limited by data gaps in gender, race, place of death, and urbanization status. Conclusion: PAI-related IHD mortality trends from 1999-2022 showed an overall decline in AAMRs but notable fluctuations, including a sharp rise in 2022. COVID-19 may have disrupted the hypothalamus-pituitary-adrenal (HPA) axis via ACE2-mediated mechanisms, contributing to these trends. PAI exacerbates cardiovascular risk through hypovolemia, hypotension, inflammatory cytokines (TNF-α, IL-1, IL-6), dyslipidemia (high triglycerides and LDL-c, low HDL-c), coronary calcification, and thrombosis risks. Mortality disparities were most pronounced in older adults, whites, and metropolitan populations. Further research is needed to address data gaps and explore drivers of the observed trends. Presentation: Saturday, July 12, 2025