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

Abstract

Context: Information about the risk and course of coronary artery disease (CAD) in acromegaly is limited. Objective: To evaluate CAD risk in acromegalic patients at diagnosis and after successful treatment during follow-up. Subjects and methods: Twenty-five consecutive patients (age 45.1G10.6 years, 15 women) were studied at the time of diagnosis, and 19 patients were re-evaluated after 4.6G1.1 years. The European Society of Cardiology (ESC) risk score was calculated, and a cardiac computed tomography was performed for detection and quantification (Agatston score (AS)) of coronary artery calcium (CACs). Fifty age-, sex-, and CAD risk-matched subjects and CAC data from the population-based Heinz Nixdorf Recall (HNR) study served as controls. Results: In 21 of the 25 patients, the 10-year risk of developing CAD according to the ESC risk score was low (!10%) and high (O20%) in four patients. The AS was lower than in controls (2.6G7.9 vs 66G182; PZ0.014) and less patients had a positive CAC (ASO0) (20 vs 48%, PZ0.024), which in the acromegalic patients was less than expected from the HNR study. The AS did not correlate with GH excess or disease duration. In 19 acromegalic patients, who were in remission and re-evaluated after 4.6G1.1 years, the ESC risk (PZ0.102) and the AS (PZ0.173) did not change significantly and no symptomatic CAD event occurred. Conclusion: CAD risk in newly diagnosed acromegalic patients was low and remained stable after successful treatment. CAC was lower than in controls suggesting that GH excess per se does not carry an additional CAD risk.

Active acromegaly is associated with decreased hs-CRP and NT-proBNP serum levels: insights from the Belgian registry of acromegaly

“…Whether hs-CRP is a nonspecific marker of the inflammation in atherosclerotic plaques or a direct participant in the progression of atherosclerosis remains an unsettled issue (28). Nevertheless, the present finding in acromegaly suggests less inflammation and a lower tendency to atheromatosis and this seems to be confirmed by clinical data (6,7). It could therefore be speculated that a low hs-CRP level in active acromegaly counteracts the risk caused by other cardiovascular risk factors, such as hypertension and diabetes.…”

“…In later stages, impaired systolic function evolving to heart failure may occur. In contrast, no increased prevalence of coronary artery disease was found in patients with newly diagnosed acromegaly (6,7). Similarly, the extent of carotid atherosclerosis and carotic internal media thickening in acromegalic patients was not higher than that in non-acromegalic subjects (6,8).…”

“…Similarly, the extent of carotid atherosclerosis and carotic internal media thickening in acromegalic patients was not higher than that in non-acromegalic subjects (6,8). The reasons for this unexpected observation are still unclear, but this finding suggests that the known atherogenic effects of hypertension, insulin resistance, and diabetes induced by GH excess (9) are counterbalanced by cardioprotective factors (7).…”

Ambulatory arterial stiffness indexes in acromegaly

“…Alterations of the vascular system include endothelial dysfunction (7) and a specific cardiomyopathy (8) characterized by left ventricular concentric hypertrophy and diastolic dysfunction. The incidences of coronary artery atherosclerosis (9) and myocardial infarction (10) are, however, similar to those found in the general population.…”

Ilościowa ocena funkcji mięśnia sercowego techniką śledzenia markerów akustycznych u pacjenta z akromegalią i chorobą wieńcową

“…Liczne czynniki ryzyka, takie jak: wiek, płeć, nadciśnienie tętnicze, cukrzyca i dyslipidemia, w tym przypadku sprzyjały rozwojowi CAD. Tym niemniej nie ma danych wskazujących na to, aby sama akromegalia zwiększała ryzyko występowania CAD [3]. …”