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Amelioration of cardiovascular risk factors with partial biochemical control of acromegaly
Author(s) -
Delaroudis Sideris P.,
Efstathiadou Zoe A.,
Koukoulis George N.,
Kita Marina D.,
Farmakiotis Dimitrios,
Dara Ourania G.,
Goulis Dimitrios G.,
Makedou Areti,
Makris Pantelis,
Slavakis Aris,
Avramides Avraam I.
Publication year - 2008
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.1365-2265.2008.03181.x
Subject(s) - medicine , endocrinology , acromegaly , fibrinogen , triglyceride , blood pressure , insulin , body mass index , lipid profile , c reactive protein , insulin resistance , cholesterol , hormone , inflammation , growth hormone
Summary Objective Complete remission of acromegaly is associated with favourable changes in cardiovascular risk parameters. We evaluated the effects of suboptimal therapy on haemodynamic, metabolic, inflammatory and coagulation cardiovascular risk indices. Design and methods Eighteen acromegalic patients on somatostatin analogues, with incomplete biochemical control, were evaluated at diagnosis and 6 months after treatment and compared to 15 healthy age‐ and body mass index (BMI)‐matched controls. Measurements of blood pressure, GH, IGF‐I, glucose, insulin, glycated haemoglobin (HbA1c), lipids, apolipoprotein A1 (apoA1), apoB, high‐sensitivity C‐reactive protein (hs‐CRP), fibrinogen, plasminogen activator inhibitor 1 (PAI‐1), tissue plasminogen activator (tPA) and circulating thrombomodulin were performed in all study participants, followed by an oral glucose tolerance test (OGTT). Insulin sensitivity (IS) was expressed by the Matsuda index (OGTT ISI ). Results Partial control of acromegaly resulted in a significant reduction in systolic and diastolic blood pressure, glucose, insulin, HbA1c, total (T‐C) and low density lipoprotein cholesterol (LDL‐C) and triglyceride levels, and a significant increase in apoA1, high density lipoprotein cholesterol (HDL‐C) and OGTT ISI compared to pretreatment levels. Plasma fibrinogen and PAI‐1 levels fell significantly [respectively (mean ± SEM), 11·04 ± 0·41 vs. 10·12 ± 0·34 µmol/l, P = 0·003 and 9·6 ± 1·97 vs. 6·55 ± 1·89 µg/l, P < 0·001]. However, a marked reduction in tPA [median (IQR) 5·1 (2·5–15) vs. 3·4 (2·4–8·6) µg/l, P = 0·031] and an increase in hs‐CRP [median (IQR) 0·05 (0·03–0·11) vs. 0·1 (0·06–0·23) mg/l, P < 0·001] were also noted. On treatment, acromegalic patients were comparable to controls, except for OGTT ISI , lipoprotein(a) [Lp(a)], fibrinogen and tPA and HDL‐C levels. Thrombomodulin and apoB levels were not affected by treatment. Conclusions Partial control in disease activity following somatostatin analogues results in significant improvement in a considerable number of cardiovascular risk markers in acromegaly.