Low risk of coronary artery disease in patients with acromegaly

Abstract

The aims of this study are to determine the prevalence of coronary atherosclerosis in acromegalic patients and to investigate the relationship between the coronary artery calcium score (CS) and acromegaly status and clinical parameters [Framingham risk score (FRS)]. Fifty-six acromegalic patients and paired non-acromegalic volunteers were stratified according to the FRS into low-, intermediate-, and high-risk groups. CS was assessed using multidetector computed tomography. The patients were considered to have controlled or active acromegaly at the time they were submitted to evaluation. Sixty-six percent of acromegalic patients exhibited arterial hypertension, 36 % had diabetes mellitus, and 34 % had hypercholesterolemia. The median FRS and the median risk for cardiovascular event within the next 10 years were similar in the acromegalics and the controls. The median total CS and CS >75th percentile didn't differ significantly between these groups. In patients with controlled acromegaly, a low, intermediate, or high FRS risk was observed in 86, 14, and 0 %, respectively. In patients with active disease, a low, intermediate, or high FRS risk was verified in 94, 3, and 3 %, respectively, and differences between the controlled and active groups were not significant. Seventy-two percent of the patients had total CS = 0, and there were no differences between the controlled and active groups. The risk of coronary artery disease in acromegalic patients, determined according to FRS and CS, is low despite the high prevalence of metabolic abnormalities.

Increased Risk of Persistent Glucose Disorders After Control of Acromegaly

“…Of note, the prevalence of myocardial infarction was similar in our study and French epidemiological data (~2%), whereas the prevalence of stroke was much higher in our patients (3.8% vs 0.6%). Concordant with our results, dos Santos Silva et al [ 27 ] had shown that patients with acromegaly were at low risk of coronary artery disease despite the high prevalence of metabolic abnormalities, whatever the phase (active or controlled) of the disease. This low number, in contrast to the data reported by Holdaway et al [ 6 ], in which out of 72 patients, 50% of deaths were related to cardiovascular diseases and 8% to strokes, is probably explained by the fact that we only focused on controlled patients and not on the whole cohort of patients with acromegaly.…”

Advances in Research on the Cardiovascular Complications of Acromegaly

“…IGF-1 in atherosclerotic plaques could prevent plaque instability by regulating the renewal of smooth muscle cells and changing the phenotype of smooth muscle cells ( 87 ). Some studies have shown that patients with acromegaly have not found an increased risk of coronary heart disease ( 88 – 91 ). dos Santos Silva et al.…”

“…Interestingly, no difference was found. According to the FS and CACs to assess the risk of ischemic events, 91% of patients with acromegaly were classified as low-risk ( 88 ). Similarly, the study by Akutsu et al.…”

“…IGF-1 in atherosclerotic plaques could prevent plaque instability by regulating the renewal of smooth muscle cells and changing the phenotype of smooth muscle cells (87). Some studies have shown that patients with acromegaly have not found an increased risk of coronary heart disease (88)(89)(90)(91). dos Santos Silva et al compared the coronary artery calcium scores (CACs) and Framingham risk score (FS) of 56 patients with acromegaly and the control group (matched by sex, age, smoking habits, hypertension, diabetes and hypercholesterolemia).…”

Vplyv hypersekrécie rastového hormónu na kardiovaskulárny systém / Effect of growth hormone hypersecretion on the cardiovascular system

“…Napriek tomu väčšina štúdií do dnešného dňa nepreukázala vyššiu prevalenciu koronarosklerózy v porovnaní s bežnou populáciou. V dodnes najväčšej realizovanej štúdii hodnotiacej obsah kalcia v stene koronárnej artérie sa nepreukázal významný rozdiel medzi bežnou populáciou a pacientmi s aktívnou akromegáliou (25). Riziko aterosklerózy u akromegalikov lepšie koreluje s prítomnosťou klasických rizikových fakto-rov KVS ochorení (fajčenie, obezita, inzulínová rezistencia, hyperglykémia, poruchy metabolizmu lipidov) než s nadprodukciou GH/IGF-1.…”