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Sex-Specific Risk of Cardiovascular Disease in Autoimmune Addison Disease-A Population-Based Cohort Study

Jakob Skov1, Anders Sundström2, Jonas F Ludvigsson3

  • 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

The Journal of Clinical Endocrinology and Metabolism
|January 5, 2019
PubMed

Insights

Cardiovascular disease (CVD) risk, particularly ischemic heart disease (IHD), is elevated in autoimmune Addison disease (AAD), especially for women. Higher glucocorticoid and mineralocorticoid doses correlate with increased CVD risk in women with AAD.

Area of Science:

  • Endocrinology
  • Cardiology
  • Epidemiology

Background:

  • Autoimmune Addison disease (AAD) is an endocrine disorder with limited known associations with cardiovascular disease (CVD).
  • Inadequate glucocorticoid replacement therapy may potentially elevate CVD risk in AAD patients.

Purpose of the Study:

  • To investigate the risk of CVD, specifically ischemic heart disease (IHD) and cerebrovascular disease (CeVD), in individuals with AAD.
  • To explore the relationship between glucocorticoid and mineralocorticoid dosing and CVD risk in AAD patients.

Main Methods:

  • A cohort-control study utilizing Swedish health registries from 1964 to 2013.
  • Identification of 1500 AAD patients and 13,758 matched controls, with incident CVD analyzed from 2006 to 2013.
  • Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs), with stratification of hormone replacement doses to assess dose-related risks.

Main Results:

  • Patients with AAD experienced a higher incidence of CVD (10.7/1000 PY) compared to controls (7.0/1000 PY).
  • Ischemic heart disease (IHD) risk was significantly increased in women with AAD (aHR, 2.15) but not in men (aHR, 1.16).
  • No increased risk for cerebrovascular disease (CeVD) was observed in either sex. Higher glucocorticoid and mineralocorticoid doses were associated with increased CVD risk in women with AAD.

Conclusions:

  • Autoimmune Addison disease is associated with an increased risk of IHD, particularly in women.
  • The risk of CVD in women with AAD is independently correlated with higher doses of glucocorticoid and mineralocorticoid replacement.
  • Close monitoring and proactive management of CVD risk factors are recommended for women with AAD.
Abstract

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