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Vascular Health in Patients in Remission of Cushing's Syndrome Is Comparable With That in BMI-Matched Controls
M A E M Wagenmakers1, S H P P Roerink1, T H A Schreuder1
1Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
Insights
Vascular health in patients with Cushing's syndrome (CS) appears to recover after long-term remission. This suggests hypercortisolism's vascular effects are reversible if comorbidities are managed.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Vascular Biology
Background:
- Active Cushing's syndrome (CS) is linked to endothelial dysfunction and early atherosclerosis.
- Long-term vascular health recovery after CS remission is not well-established.
- Understanding vascular health post-CS is crucial for cardiovascular disease risk assessment.
Purpose of the Study:
- To assess micro- and macrovascular health in patients with long-term Cushing's syndrome remission.
- To compare vascular health in patients with CS in remission versus healthy controls.
- To determine if vascular impairment persists after Cushing's syndrome remission, considering comorbidities.
Main Methods:
- Cross-sectional case-control study involving 63 patients in remission (≥ 4 years) and 63 matched healthy controls.
- Group A: Assessed serum biomarkers, intima media thickness, pulse wave velocity, and pulse wave analysis.
- Group B: Evaluated endothelium-dependent and -independent vasodilation, including flow-mediated dilation and forearm resistance artery responses.
Main Results:
- No significant differences were found in vascular health outcome measures between CS remission patients and controls.
- Both groups A and B showed comparable results for all assessed vascular parameters.
- This indicates no persistent impairment in micro- or macrovascular function.
Conclusions:
- Vascular health in patients with long-term Cushing's syndrome remission is comparable to healthy controls.
- Reversibility of hypercortisolism's vascular effects is suggested, provided comorbidities are controlled.
- Emphasizes the importance of stringent management of metabolic comorbidities in CS patients.
Context:
In active Cushing's syndrome (CS), patients suffer from endothelial dysfunction and premature atherosclerosis. However, it is uncertain to what extent vascular health recovers after long-term remission. This is highly relevant because this topic relates to future development of cardiovascular disease.
Objective:
The objective of the study was to investigate whether micro- and macrovascular health is impaired after long-term remission of CS in patients with no or adequately treated comorbidities.
Design And Setting:
This was a cross-sectional case-control study in two tertiary referral centers.
Patients And Main Outcome Measures:
Sixty-three patients (remission of CS for ≥ 4 y) and 63 healthy, well-matched controls were compared. In group A (58 patients and 58 controls), serum biomarkers associated with endothelial dysfunction, intima media thickness, pulse wave velocity, and pulse wave analysis were studied. In group B (14 patients and 14 controls), endothelium-dependent and -independent vasodilatation was studied in conduit arteries (flow mediated dilation of the brachial artery) and forearm skeletal muscle resistance arteries (vasodilator response to intraarterial acetylcholine, sodium-nitroprusside, and NG-monomethyl-L-arginine using venous occlusion plethysmography).
Results:
There were no significant differences between the outcome measures of vascular health of patients and controls in groups A and B.
Conclusion:
The vascular health of patients in long-term remission of CS seems to be comparable with that of healthy gender-, age-, and body mass index-matched controls, provided that the patients have no, or adequately controlled, comorbidities. Therefore, the effects of hypercortisolism per se on the vasculature may be reversible. This accentuates the need for the stringent treatment of metabolic comorbidities in these patients.
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