Maria Cristina Costa de Almeida , Claudia Maria Vilas Freire , Maria do Carmo P. Nunes , Beatriz Santana Soares , Marcia M. Barbosa , Alexandre Varella Giannetti , Giancarlo Pereira Zille , Paulo Augusto Carvalho Miranda , Antonio Ribeiro-Oliveira Jr , Juliana Beaudette Drummond
{"title":"“Subclinical atherosclerosis in acromegaly: Possible association with cardiovascular risk factors rather than disease activity”","authors":"Maria Cristina Costa de Almeida , Claudia Maria Vilas Freire , Maria do Carmo P. Nunes , Beatriz Santana Soares , Marcia M. Barbosa , Alexandre Varella Giannetti , Giancarlo Pereira Zille , Paulo Augusto Carvalho Miranda , Antonio Ribeiro-Oliveira Jr , Juliana Beaudette Drummond","doi":"10.1016/j.ghir.2021.101442","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Cardiovascular (CV) disease is still a major cause of excessive morbidity and mortality in patients<span><span><span> with active acromegaly, which may be attributed to a high prevalence of associated pro-atherosclerotic risk factors. However, a direct effect of GH/IGF-1 excess on the </span>vasculature has been previously suggested, warranting further investigation. The present study was designed to investigate whether chronic GH/IGF-1 excess is associated with an increased prevalence of subclinical </span>atherosclerosis in patients with acromegaly.</span></p></div><div><h3>Design</h3><p><span>We measured carotid intima-media thickness (cIMT) and assessed carotid plaques by ultrasonography along with classical CV risk factors in 54 acromegaly patients (34 females, 50 ± 12 years and compared those with 62 (42 females, 53 ± 13 years) age-, sex- and CV risk factors- matched controls. In order to compare cIMT measurements between patients and controls we analyzed </span>common carotid artery far wall data as well as a combined measurement result, which consisted of the mean value of the six different measurements, three at each side.</p></div><div><h3>Results</h3><p><span><span>mean ± SD serum GH and IGF-1 levels were 2.76 ± 4.65 ng/mL and 1.7 ± 1.25 x ULN, respectively, in all acromegaly patients. Age, </span>body mass index<span>, blood pressure, lipid levels, fasting glucose and Framingham's global cardiovascular risk score classification were similar comparing patients and controls. Combined median [IQR] cIMT measurements were similar in acromegaly patients and matched controls (0.59 [0.52–0.66] mm vs. 0.59 [0.52–0.69] mm; </span></span><em>P</em> = 0.872) as well as in acromegaly patients with active and controlled disease (0.59 [0.51–0.68] mm vs. 0.60 [0.54–0.68] mm; <em>P</em> = 0.385). No significant correlations were observed between cIMT measurements and GH (Spearman <em>r</em> = 0.1, <em>P</em> = 0.49) or IGF-1 (Spearman <em>r</em> = 0.13, <em>P</em><span> = 0.37) levels in patients with acromegaly. Carotid atherosclerotic plaques prevalence was similar in patients and controls (26% vs. 32%; </span><em>P</em> = 0.54) as well as in patients with active and controlled acromegaly (22% vs. 30%; <em>P</em> = 0.537).</p></div><div><h3>Conclusions</h3><p>Our data suggest that GH/IGF-1 excess itself is not one of the main drivers of subclinical morphological atherosclerosis changes in patients with acromegaly and that optimal control of acromegaly-associated CV risk factors may preserve vasculature structure even when strict biochemical control is not achieved.</p></div>","PeriodicalId":12803,"journal":{"name":"Growth Hormone & Igf Research","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Growth Hormone & Igf Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1096637421000654","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CELL BIOLOGY","Score":null,"Total":0}
引用次数: 1
Abstract
Objective
Cardiovascular (CV) disease is still a major cause of excessive morbidity and mortality in patients with active acromegaly, which may be attributed to a high prevalence of associated pro-atherosclerotic risk factors. However, a direct effect of GH/IGF-1 excess on the vasculature has been previously suggested, warranting further investigation. The present study was designed to investigate whether chronic GH/IGF-1 excess is associated with an increased prevalence of subclinical atherosclerosis in patients with acromegaly.
Design
We measured carotid intima-media thickness (cIMT) and assessed carotid plaques by ultrasonography along with classical CV risk factors in 54 acromegaly patients (34 females, 50 ± 12 years and compared those with 62 (42 females, 53 ± 13 years) age-, sex- and CV risk factors- matched controls. In order to compare cIMT measurements between patients and controls we analyzed common carotid artery far wall data as well as a combined measurement result, which consisted of the mean value of the six different measurements, three at each side.
Results
mean ± SD serum GH and IGF-1 levels were 2.76 ± 4.65 ng/mL and 1.7 ± 1.25 x ULN, respectively, in all acromegaly patients. Age, body mass index, blood pressure, lipid levels, fasting glucose and Framingham's global cardiovascular risk score classification were similar comparing patients and controls. Combined median [IQR] cIMT measurements were similar in acromegaly patients and matched controls (0.59 [0.52–0.66] mm vs. 0.59 [0.52–0.69] mm; P = 0.872) as well as in acromegaly patients with active and controlled disease (0.59 [0.51–0.68] mm vs. 0.60 [0.54–0.68] mm; P = 0.385). No significant correlations were observed between cIMT measurements and GH (Spearman r = 0.1, P = 0.49) or IGF-1 (Spearman r = 0.13, P = 0.37) levels in patients with acromegaly. Carotid atherosclerotic plaques prevalence was similar in patients and controls (26% vs. 32%; P = 0.54) as well as in patients with active and controlled acromegaly (22% vs. 30%; P = 0.537).
Conclusions
Our data suggest that GH/IGF-1 excess itself is not one of the main drivers of subclinical morphological atherosclerosis changes in patients with acromegaly and that optimal control of acromegaly-associated CV risk factors may preserve vasculature structure even when strict biochemical control is not achieved.
目的:心血管(CV)疾病仍然是活动性肢端肥大症患者高发病率和高死亡率的主要原因,这可能归因于相关的促动脉粥样硬化危险因素的高患病率。然而,GH/IGF-1过量对脉管系统的直接影响已经被提出,需要进一步的研究。本研究旨在探讨慢性GH/IGF-1过量是否与肢端肥大症患者亚临床动脉粥样硬化患病率增加有关。我们测量了54例肢端肥大症患者(34例女性,50±12岁)的颈动脉内膜-中膜厚度(cIMT),并通过超声检查评估了颈动脉斑块以及典型的心血管危险因素,并与62例(42例女性,53±13岁)年龄、性别和心血管危险因素匹配的对照组进行了比较。为了比较患者和对照组之间的cIMT测量结果,我们分析了颈总动脉远壁数据以及联合测量结果,该结果由六种不同测量值的平均值组成,每侧三种。结果所有肢端肥大症患者的平均±SD血清GH和IGF-1水平分别为2.76±4.65 ng/mL和1.7±1.25 x ULN。患者和对照组的年龄、体重指数、血压、血脂水平、空腹血糖和Framingham全球心血管风险评分分类相似。肢端肥大症患者和匹配对照组的中位cIMT测量值相似(0.59 [0.52-0.66]mm vs. 0.59 [0.52-0.69] mm;P = 0.872)以及活动性和控制疾病的肢端肥大症患者(0.59 [0.51-0.68]mm vs. 0.60 [0.54-0.68] mm;p = 0.385)。肢端肥大症患者的cIMT测量与GH (Spearman r = 0.1, P = 0.49)或IGF-1 (Spearman r = 0.13, P = 0.37)水平无显著相关性。患者和对照组的颈动脉粥样硬化斑块患病率相似(26% vs. 32%;P = 0.54)以及活动性和控制性肢端肥大症患者(22% vs. 30%;p = 0.537)。结论GH/IGF-1过量本身并不是肢端肥大症患者亚临床形态动脉粥样硬化改变的主要驱动因素之一,即使没有严格的生化控制,对肢端肥大相关的心血管危险因素的最佳控制也可能保留血管结构。
期刊介绍:
Growth Hormone & IGF Research is a forum for research on the regulation of growth and metabolism in humans, animals, tissues and cells. It publishes articles on all aspects of growth-promoting and growth-inhibiting hormones and factors, with particular emphasis on insulin-like growth factors (IGFs) and growth hormone. This reflects the increasing importance of growth hormone and IGFs in clinical medicine and in the treatment of diseases.