Markers of atherosclerosis in patients with Cushing’s syndrome: a meta-analysis of literature studies

Abstract

CS is significantly associated with markers of subclinical atherosclerosis and CV risk. These findings could help establish more specific CV prevention strategies in this clinical setting. Key messages A series of studies reported an increased cardiovascular risk in patients with Cushing's syndrome (CS). In the present meta-analysis we demonstrated that CS is associated with an increased intima-media thickness, higher prevalence of carotid plaques, and lower flow-mediated dilation as compared with controls. These data consistently suggest the need for a strict monitoring of early signs of subclinical atherosclerosis in CS patients.

Translational evidence of prothrombotic and inflammatory endothelial damage in Cushing syndrome after remission

“…As expected, ACS presented various cardiometabolic comorbidities, while both ACS and RCS presented, as compared to matched CTR, increased inflammatory parameters such as hs‐CRP, fibrinogen and an increased WHR . Interestingly, platelet number was increased only in ACS, while in RCS, platelet number correlated with sVCAM‐1.…”

“…Several studies have demonstrated that remission of CS is associated with a significant improvement of metabolic parameters, although recovery is incomplete in the vast majority of cases, maintaining an increased cardiovascular risk . The mechanisms implicated are unclear and might involve vascular and circulatory factors due to the nonphysiological adrenal replacement therapy, another hormonal deficiency (growth or sexual hormones) and the persistence of increased visceral adipose tissue with deleterious cytokine secretion, maintaining an inflammatory and prothrombotic state and metabolic syndrome‐like features …”

“…Sustained evidence from clinical observational studies clustered in the two recent reviews by Colao et al and di Minno et al indicates that some clinical features of CS might remain resistant to change after correction of cortisol excess . Increased cardiovascular risk persists in patients with CS even 5 years after its successful remission, due to the maintenance of increased waist/hip ratio, diastolic blood pressure, total/HDL cholesterol ratio and plasma inflammatory markers, as compared with controls matched for body mass index (BMI) and age .…”

Aortic pulse wave velocity in children with Cushing syndrome: A window into a marker of early cardiovascular disease

“…Additionally, cardiovascular remodelling may be one of the permanent sequelae of long‐standing CS and underscores the importance of early detection and treatment in children . A recent meta‐analysis of 14 studies of atherosclerosis in adult patients with CS showed that CS is significantly associated with subclinical markers of atherosclerosis and cardiovascular risk …”

“…An excess of cortisol is also linked to vascular damage, which may lead to cardiovascular complications in CS patients . It has been shown that adult patients with CS have significantly increased carotid intima‐media thickness and a higher incidence of well‐defined plaque walls than control populations with the same cardiovascular risk factors . Furthermore, adult patients with CS had increased left and right ventricular hypertrophy, and lower left atrial ejection fractions and increased end‐diastolic left ventricular segmental thickness compared to the normal population .…”