Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them?

Abstract

Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.

Acromegaly, inflammation and cardiovascular disease: a review

“…Arrhythmias and cardiac valvular disease are also more common in acromegaly patients compared to the general population [6,7]. Treatment is reported to decrease the incidence of arrhythmias and prevent further deterioration, but did not reverse established cardiac valve disease [7,36,60].…”

“…Reports on the risk of coronary artery disease (CAD) and the presence of coronary calcifications are inconsistent, but the prevalence of clinically apparent CAD is similar in wellcontrolled acromegaly patients (2.5-12%) compared to the general population [7,[61][62][63][64]. Likely, the risk of apparent CAD is a consequence of concomitant traditional CVD risk factors rather than direct effects of GH or IGF-1 [7,36,63], and consequently, acromegaly treatment reduces risk of CAD via amelioration of CVD risk factors [65]. However, coronary microvascular dysfunction, which has been associated with the development of macrovascular coronary disease, has been reported in patients with controlled and active acromegaly without overt CAD.…”

“…[1,2]. GH and IGF-1 excess exerts many actions on the cardiovascular (CV) system, and CV comorbidities and disease (CVD) risk factors are common, especially in active acromegaly [3][4][5], but often persist after adequate treatment in patients with controlled disease [6][7][8][9]. Circulating IGF-1 inhibits GH secretion via direct negative feedback on the pituitary and also indirectly via stimulating hypothalamic somatostatin secretion [10].…”

“…The mechanism by which these factors impact on the risk of CVD may be different than in the general population. Despite their unclear significance regarding overt macrovascular damage in acromegaly, cardiovascular derangements represent a therapy challenge and a clinical burden, that require intensive management and negatively impact on QoL [7,15].…”

Natural History of Acromegaly: Incidences, Re-operations, Cancers, and Mortality Rates in a National Cohort

“…There are also complications such as diabetes, sleep apnea, and high blood pressure. It is thus reasonable to expect an association of acromegaly with higher chances of cancer [3], increased risks of cardiovascular diseases [4], and mortality [5][6][7][8]. Although there have been reports on its association with premature mortality from cardiopulmonary diseases and certain malignancies, the exact incidences, risk of cancers, and rates of mortality remain elusive.…”