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Should Cushing's Syndrome be Considered as a Disease with High Cardiovascular Risk in Relevant Guidelines?
Goran Koracevic1,2, Milan Stojkovic2, Dragan Lovic3
1Department for Cardiovascular Diseases, Clinical Centre, Nis, Serbia.
Insights
Cushing's syndrome (CS) significantly increases mortality due to cardiovascular disease (CVD) risk factors like hypertension and diabetes. This review examines evidence for classifying CS as a high CVD risk condition.
Area of Science:
- Endocrinology
- Cardiology
- Metabolic Diseases
Background:
- Cushing's syndrome (CS) is linked to a 1.8-7.4-fold increase in mortality.
- CS patients exhibit high rates of cardiovascular disease (CVD) risk factors, including adiposity, arterial hypertension (AHT), dyslipidemia, and type 2 diabetes mellitus (T2DM).
- The metabolic syndrome (MetS) is nearly universal in CS patients, indicating a substantial CVD risk.
Purpose of the Study:
- To review the evidence supporting the classification of Cushing's syndrome (CS) as a high cardiovascular disease (CVD) risk condition.
- To highlight the significant CVD risk associated with CS, even in younger patients.
- To discuss the implications of CS on metabolic health and its contribution to CVD.
Main Methods:
- Literature review of studies investigating mortality and cardiovascular risk factors in Cushing's syndrome.
- Analysis of clinical guidelines and epidemiological data.
- Synthesis of evidence linking CS to metabolic syndrome and major adverse cardiovascular events.
Main Results:
- CS is associated with a high prevalence of metabolic syndrome and multiple CVD risk factors.
- A significant proportion of CS patients present with high or very high 10-year CVD event risk.
- CS is also recognized as a risk factor for aortic dissection.
Conclusions:
- Cushing's syndrome (CS) should be recognized as a high cardiovascular disease (CVD) risk condition.
- The high occurrence of CVD risk factors and metabolic syndrome in CS underscores its significant impact on cardiovascular health.
- Further consideration of CS in CVD risk stratification is warranted.
Abstract:
A considerable amount of data supports a 1.8-7.4-fold increased mortality associated with Cushing's syndrome (CS). This is attributed to a high occurrence of several cardiovascular disease (CVD) risk factors in CS [e.g. adiposity, arterial hypertension (AHT), dyslipidaemia and type 2 diabetes mellitus (T2DM)]. Therefore, practically all patients with CS have the metabolic syndrome (MetS), which represents a high CVD risk. Characteristically, despite a relatively young average age, numerous patients with CS display a 'high' or 'very high' CVD risk (i.e. risk of a major CVD event >20% in the following 10 years). Although T2DM is listed as a condition with a high CVD risk, CS is not, despite the fact that a considerable proportion of the CS population will develop T2DM or impaired glucose tolerance. CS is also regarded as a risk factor for aortic dissection in current guidelines. This review considers the evidence supporting listing CS among high CVD risk conditions.