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Published on: February 7, 2015
Changes in arterial stiffness but not carotid intimal thickness in acromegaly
A N Paisley1, M Banerjee, M Rezai
1Department of Endocrinology, The Christie National Health Service Foundation Trust, Manchester M20 4BX, United Kingdom. anpaisley@doctors.org.uk
Insights
Patients with acromegaly exhibit increased arterial stiffness, indicated by higher aortic pulse wave velocity (PWV). This arterial stiffening, along with left ventricular changes, likely contributes to premature cardiovascular disease in acromegaly patients.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Biology
Background:
- Acromegaly is associated with increased cardiovascular morbidity.
- Arterial stiffness and left ventricular hypertrophy are hypothesized contributors to this morbidity.
Purpose of the Study:
- To investigate arterial stiffness and left ventricular structure in acromegaly patients.
- To determine if increased arterial stiffness and left ventricular hypertrophy are linked to cardiovascular disease in acromegaly.
Main Methods:
- Fifty-six acromegaly patients and 46 healthy controls underwent measurements of aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT), and echocardiography.
- Cardiovascular risk factors were also assessed.
Main Results:
- Acromegaly patients showed significantly higher systolic blood pressure and PWV compared to controls.
- No significant difference in carotid IMT was observed between patients and controls.
- Left ventricular mass was numerically higher in acromegaly patients, though not statistically significant.
Conclusions:
- Patients with acromegaly have increased aortic PWV, indicating arterial stiffening, independent of other risk factors.
- Cardiovascular disease in acromegaly is likely due to pressure-related arterial and left ventricular stiffening, rather than atherosclerosis.
Context:
Acromegaly increases cardiovascular morbidity. We tested the hypothesis that increased arterial stiffness together with left ventricular hypertrophy may be a contributory factor.
Patients And Design:
Fifty-six patients (40 males, 54 ± 13 yr; 25 active disease, 31 in remission) and 46 healthy controls (30 males, 52 ± 13 yr) underwent measurements of aortic pulse wave velocity (PWV), carotid Doppler (IMT), echocardiography, and cardiovascular risk factors.
Results:
Mean serum IGF-I was 323 ± 286 ng/ml (sd score 1.8 ± 1.9) in all patients. Age, body mass index, diastolic blood pressure (BP), and lipid levels were similar comparing patients and controls. Systolic BP (130.8 ± 19.9 vs. 122 ± 14 mm Hg controls, P < 0.01) and PWV (11.7 ± 3.8 vs. 9.7 ± 2.8 m/sec, 95% confidence interval -3.4 to -0.7, P <0.01) were higher in patients than controls. Regression analysis revealed age, presence of acromegaly, systolic BP, and body mass index, inversely, as significantly and independently associated with PWV. No difference in carotid IMT was seen (0.8 ± 0.2 patients vs. 0.7 ± 0.2 mm controls, P = 0.5) or between active/controlled disease. In the subset of participants with echocardiography (n = 32), left ventricular mass was higher by a mean of 38.2 g (95% confidence interval -80.9 to +4.6, P = 0.08).
Conclusion:
In summary, patients with acromegaly had independently and significantly increased aortic PWV as evidence of arterial stiffening but unaltered carotid IMT compared with controls, also influenced by age and systolic BP. Premature cardiovascular disease in patients with acromegaly is likely related to pressure-related arterial and left ventricular stiffening rather than atherosclerotic disease.
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