Effects of somatostatin analog treatment on cardiovascular parameters in patients with acromegaly: A systematic review

Heidarpour, Maryam; Shafie, Davood; Aminorroaya, Ashraf; Sarrafzadegan, Nizal; Farajzadegan, Ziba; Nouri, Rasool; Najimi, Arash; Dimopolou, Christina; Stalla, Günter

doi:10.4103/jrms.jrms_955_18

Cited by 6 publications

(2 citation statements)

References 104 publications

(344 reference statements)

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“…The chronic cardiotoxic and remodeling effects of GH/IGF-1 overload results in concentric biventricular hypertrophic cardiomyopathy, which may lead to heart failure [3,6,53], especially in patients with insufficiently controlled acromegaly [54,55]. Acromegaly treatment reverses some of the early stage morphological changes and improves cardiac function, especially when IGF-1 levels were normalized [36,[56][57][58][59].…”

Section: Acromegalic Cardiomyopathymentioning

confidence: 99%

Acromegaly, inflammation and cardiovascular disease: a review

Wolters¹,

Netea

Riksen³

et al. 2020

Rev Endocr Metab Disord

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Acromegaly is characterized by Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) excess. Uncontrolled acromegaly is associated with a strongly increased risk of cardiovascular disease (CVD), and numerous cardiovascular risk factors remain present after remission. GH and IGF-1 have numerous effects on the immune and cardiovascular system. Since endothelial damage and systemic inflammation are strongly linked to the development of CVD, and have been suggested to be present in both controlled as uncontrolled acromegaly, they may explain the presence of both micro- and macrovascular dysfunction in these patients. In addition, these changes seem to be only partially reversible after remission, as illustrated by the often reported presence of endothelial dysfunction and microvascular damage in controlled acromegaly. Previous studies suggest that insulin resistance, oxidative stress, and endothelial dysfunction are involved in the development of CVD in acromegaly. Not surprisingly, these processes are associated with systemic inflammation and respond to GH/IGF-1 normalizing treatment.

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Section: Acromegalic Cardiomyopathymentioning

confidence: 99%

Acromegaly, inflammation and cardiovascular disease: a review

Wolters¹,

Netea

Riksen³

et al. 2020

Rev Endocr Metab Disord

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“…The most frequent side effects of SSAs consist mainly of gastrointestinal toxicities, with potentially a beneficial effect on cardiac parameters in the setting of acromegalic heart disease, a constellation of cardiac complications associated with acromegaly that involves nearly all aspects of the cardiovascular system [ 9 ]. In addition, SSAs and TPH inhibitors inhibit serotonin secretion from the tumor and subsequently lower 5-HIAA levels, relieving carcinoid syndrome, a rare secretory syndrome mainly associated with small intestinal and bronchial NENs that becomes manifest when serotonin and other vasoactive substances from the tumor enter the systemic circulation escaping hepatic degradation [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Toxicities Secondary to Biotherapy and Molecular Targeted Therapies in Neuroendocrine Neoplasms: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Aktypis

Spei

Yavropoulou

et al. 2021

Cancers

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A broad spectrum of novel targeted therapies with prime antitumor activity and/or ample control of hormonal symptoms together with an overall acceptable safety profile have emerged for patients with metastatic neuroendocrine neoplasms (NENs). In this systematic review and quantitative meta-analysis, the PubMed, EMBASE, Cochrane Central Register of Controlled Trials and clinicaltrials.gov databases were searched to assess and compare the safety profile of NEN treatments with special focus on the cardiovascular adverse effects of biotherapy and molecular targeted therapies (MTTs). Quality/risk of bias were assessed using GRADE criteria. Placebo-controlled randomized clinical trials (RCTs) in patients with metastatic NENs, including medullary thyroid cancer (MTC) were included. A total of 3695 articles and 122 clinical trials registered in clinicaltrials.gov were screened. We included sixteen relevant RCTs comprising 3408 unique patients assigned to different treatments compared with placebo. All the included studies had a low risk of bias. We identified four drug therapies for NENs with eligible placebo-controlled RCTs: somatostatin analogs (SSAs), tryptophan hydroxylase (TPH) inhibitors, mTOR inhibitors and tyrosine kinase inhibitors (TKI). Grade 3 and 4 adverse effects (AE) were more often encountered in patients treated with mTOR inhibitors and TKI (odds ratio [OR]: 2.42, 95% CI: 1.87–3.12 and OR: 3.41, 95% CI: 1.46–7.96, respectively) as compared to SSAs (OR:0.77, 95% CI: 0.47–1.27) and TPH inhibitors (OR:0.77, 95% CI: 0.35–1.69). MTOR inhibitors had the highest risk for serious cardiac AE (OR:3.28, 95% CI: 1.66–6.48) followed by TKIs (OR:1.51, 95% CI: 0.59–3.83). Serious vascular AE were more often encountered in NEN patients treated with mTOR inhibitors (OR: 1.72, 95% CI: 0.64–4.64) and TKIs (OR:1.64, 95% CI: 0.35–7.78). Finally, patients on TKIs were at higher risk for new-onset or exacerbation of pre-existing hypertension (OR:3.31, 95% CI: 1.87–5.86). In conclusion, SSAs and TPH inhibitors appear to be safer as compared to mTOR inhibitors and TKIs with regards to their overall toxicity profile, and cardiovascular toxicities in particular. Special consideration should be given to a patient-tailored approach with anticipated toxicities of targeted NEN treatments together with assessment of cardiovascular comorbidities, assisting clinicians in treatment selection and early recognition/management of cardiovascular toxicities. This approach could improve patient compliance and preserve cardiovascular health and overall quality of life.

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Filling the gap between the heart and the body in acromegaly: a case-control study

et al. 2022

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Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. Purpose The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. Methods We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. Results Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation. Conclusion Our study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.

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Effects of somatostatin analog treatment on cardiovascular parameters in patients with acromegaly: A systematic review

Cited by 6 publications

References 104 publications

Acromegaly, inflammation and cardiovascular disease: a review

Acromegaly, inflammation and cardiovascular disease: a review

Cardiovascular Toxicities Secondary to Biotherapy and Molecular Targeted Therapies in Neuroendocrine Neoplasms: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Filling the gap between the heart and the body in acromegaly: a case-control study

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