Subclinical Atherosclerosis in Patients with Cushing Syndrome: Evaluation with Carotid Intima-Media Thickness and Ankle-Brachial Index

Abstract

BackgroundCushing syndrome (CS) has been described as a killing disease due its cardiovascular complications. In fact, chronic cortisol excess leads to a constellation of complications, including hypertension, hyperglycemia, adiposity, and thromboembolism. The main vascular alteration associated with CS is atherosclerosis.MethodsAim of this study was to analyze carotid intima-media thickness (cIMT) and ankle-brachial index (ABI), two surrogate markers of subclinical atherosclerosis in a consecutive series of CS patients, compared to patients with essential hypertension (EH) and health subjects (HS).ResultsPatients with CS showed a significant increase (P<0.05) of cIMT (0.89±0.17 mm) compared to EH (0.81±0.16 mm) and HS (0.75±0.4 mm), with a high prevalence of plaque (23%; P<0.03). Moreover, CS patients showed a mean ABI values (1.07±0.02) significantly lower respect to HS (1.12±0.11; P<0.05), and a higher percentage (20%) of pathological values of ABI (≤0.9; P<0.03).ConclusionIn conclusion, we confirmed and extended the data of cIMT in CS, and showed that the ABI represent another surrogate marker of subclinical atherosclerosis in this disease.

Micro- and Macrovascular Effects of Inflammation in Peripheral Artery Disease—Pathophysiology and Translational Therapeutic Approaches

“…In patients diagnosed with Cushing’s disease, which is characterised by endogenous overproduction of cortisone, a thickened intimal-medial layer and a lower systolic carotid artery lumen diameter [ 300 ] have been observed [ 301 ]. Furthermore, the ankle-brachial pressure index is elevated in Cushing’s disease [ 302 ]. In large register studies, glucocorticoid prescription has been associated with significant and dose-dependent increases in the risk for CVD [ 301 , 303 , 304 , 305 ].…”

Glucocorticoids: Fuelling the Fire of Atherosclerosis or Therapeutic Extinguishers?

“…Notably, this vascular remodelling occurs independent of several cardiovascular/atherosclerosis risk factors including smoking, body mass index, blood pressure, glucose levels and lipid levels. Indeed, when compared with healthy and hypertensive individuals, patients with Cushing’s show increased carotid intima-media thickness and a higher prevalence of plaques (26% vs. 0 and 16%, respectively) [ 54 ]. Cushing’s patients also demonstrated increased ankle-brachial index (ABI) compared to controls, a clinical marker of peripheral vascular disease (PVD) [ 54 ].…”

“…Indeed, when compared with healthy and hypertensive individuals, patients with Cushing’s show increased carotid intima-media thickness and a higher prevalence of plaques (26% vs. 0 and 16%, respectively) [ 54 ]. Cushing’s patients also demonstrated increased ankle-brachial index (ABI) compared to controls, a clinical marker of peripheral vascular disease (PVD) [ 54 ]. Strikingly, this evidence of increased atheroma remains beyond the remission of Cushing’s when compared to non-Cushing’s individuals, indicating irreversible consequences of systemic changes [ 19 , 55 ].…”

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“…There is 68% of increased risk of myocardial infarction among RA patients treated with GCs [148]. Cushing disease is associated with accelerated atherosclerotic vascular disease [149].…”