Acromegaly and Coronary Disease: An Integrated Evaluation of Conventional Coronary Risk Factors and Coronary Calcifications Detected by Computed Tomography

Abstract

In our study, the integrated evaluation of FS and AS showed that 41% of acromegalics are at risk for coronary atherosclerosis and that coronary calcifications were evident in about half of them despite the fact that myocardial infarction was not more frequent in acromegalic patients than the general population. Moreover, the control of acromegaly did not influence significantly the extent of coronary atherosclerosis.

Acromegaly per se does not increase the risk for coronary artery disease

“…Many patients are exposed to coronary risk factors like arterial hypertension, diabetes mellitus, or dyslipidemia promoted by chronic GH excess (1,5). Information about CAD in acromegalic patients is limited and controversial (1,(5)(6)(7)(8)(9)(14)(15)(16). Many studies investigated heterogeneous cohorts that included treatment-naive acromegalic patients, patients with uncontrolled and treatment-resistant disease, and patients in remission who were with or without various treatment regimens.…”

“…The acromegalic patients were overweight (Table 1), which, however, is unlikely to explain the results, since there is no evidence that obesity protects from CAD. CAC data (AS) from the HNR study, which comprises a large unselected population-based cohort from Germany, were used as a second independent reference cohort (14). Twenty acromegalic patients or 80% had an AS below the 25th percentile, two had an AS between the 25 and 50th percentiles, two had an AS between the 50 and 75th percentiles, and one had an AS between the 75 and 90th percentiles of the respective sex-and age-matched HNR groups.…”

“…On the other hand, there are studies questioning an increased prevalence of CAD in patients with acromegaly or even suggesting an antiatherogenic effect of GH-IGF1 excess (9,13). In one cross-sectional study, the integrated evaluation of the Framingham risk score (FS) and coronary artery calcium (CAC) as assessed by multidetector computed tomography (CT) showed that 41% of acromegalics were at risk for atherosclerosis (14). The control of acromegaly, however, did not influence the extent of coronary atherosclerosis, and the study provided indirect evidence that calcium deposits may not progress in acromegaly as in the general population, which would be consistent with a protective effect of GH excess (14).…”

“…In one cross-sectional study, the integrated evaluation of the Framingham risk score (FS) and coronary artery calcium (CAC) as assessed by multidetector computed tomography (CT) showed that 41% of acromegalics were at risk for atherosclerosis (14). The control of acromegaly, however, did not influence the extent of coronary atherosclerosis, and the study provided indirect evidence that calcium deposits may not progress in acromegaly as in the general population, which would be consistent with a protective effect of GH excess (14). In another prospective study, the risk of CAD was low, and none of the acromegalic patients developed a major cardiac event during the 5-year study period (15).…”

“…In another prospective study, the risk of CAD was low, and none of the acromegalic patients developed a major cardiac event during the 5-year study period (15). Together, the data on CAD in acromegaly are limited, controversial, mainly refer to older pathological studies or are based on mixed patient populations comprising controlled and uncontrolled acromegaly without controls matched for CAD risk factors (1,(5)(6)(7)(8)(9)(14)(15)(16).…”