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High cardiovascular risk in patients with Cushing's syndrome according to 1999 WHO/ISH guidelines
Author(s) -
Mancini Tatiana,
Kola Blerina,
Mantero Franco,
Boscaro Marco,
Arnaldi Giorgio
Publication year - 2004
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2004.02168.x
Subject(s) - medicine , diabetes mellitus , left ventricular hypertrophy , obesity , disease , endocrinology , population , cushing's disease , proteinuria , risk factor , metabolic syndrome , blood pressure , cardiology , kidney , environmental health
objective In patients with Cushing's syndrome (CS) cardiovascular complications determine a mortality rate four times higher than in an age‐ and gender‐matched population. Therefore, we calculated the global cardiovascular risk in patients with CS. design and patients We applied the World Health Organization − International Society of Hypertension (WHO/ISH) 1999 guidelines for the estimation of cardiovascular risk in 38 females and 11 males with CS; 27 pituitary adenomas, 15 adrenal adenomas, four adrenal carcinomas and three ectopic ACTH‐secreting tumours. The risk of major cardiovascular events was estimated considering the combined effect of several risk factors (hypertension, diabetes, etc.), organ damage (left ventricular hypertrophy (LVH), proteinuria, etc.) and associated pathologies. Four categories of absolute cardiovascular disease risk were defined (low, medium, high, very high). results Eighty per cent of patients presented a ‘high’ or ‘very high’ cardiovascular risk; 85·1% of the patients were hypertensive with a mild‐moderate hypertension (68%). Forty‐seven per cent of patients were diabetics and 41·3% were obese. Hyperlipidaemia was less frequent (37·5%). Fasting glycaemia was the only cardiovascular risk factor that correlated with a degree of hypercortisolism. Duration of disease correlated with the presence of obesity ( P < 0·0008) and hypertension ( P < 0·03) but not with the presence of diabetes or dyslipidaemia and seemed to be the only significant predictor of cardiovascular risk ( P = 0·03). conclusions Patients with active CS present a remarkably increased cardiovascular risk. Considering that the biochemical cure of hypercortisolism is often difficult to obtain, especially in Cushing's disease, and that cardiovascular risk could persist even after the ‘cure’, control of risk factors should be one of the primary goals of the therapy.