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Acromegaly and cardiovascular outcomes: a cohort study
Sangmo Hong1, Kyung-Soo Kim2, Kyungdo Han3
1Department of Internal Medicine, Guri Hospital, College of Medicine, Hanyang University, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea.
Insights
Patients with acromegaly face increased risks of atrial fibrillation, congestive heart failure, and death. The risk for atrial fibrillation is particularly elevated within the first four years after diagnosis.
Area of Science:
- Endocrinology
- Cardiology
- Public Health
Background:
- Acromegaly, a condition of excess growth hormone, is linked to cardiovascular complications.
- Understanding the specific risks associated with acromegaly is crucial for patient management.
Purpose of the Study:
- To investigate the population-level risk of cardiovascular disease and mortality in patients with acromegaly.
- To analyze the association between acromegaly and specific cardiovascular outcomes and all-cause death.
Main Methods:
- A nationwide, retrospective, observational cohort study was conducted.
- 1874 patients with acromegaly were compared to 9370 matched controls.
- Cox proportional hazards regression was used to analyze outcomes, adjusting for multiple covariates.
Main Results:
- Patients with acromegaly showed a higher incidence of atrial fibrillation, congestive heart failure, and all-cause mortality.
- No significant difference in myocardial infarction or stroke incidence was observed between groups.
- Adjusted analyses confirmed significantly higher risks for atrial fibrillation, congestive heart failure, and all-cause mortality in acromegaly patients.
Conclusions:
- Acromegaly significantly increases the risk of atrial fibrillation, congestive heart failure, and all-cause mortality.
- The risk of atrial fibrillation demonstrates a time-dependent relationship with acromegaly, being higher in the initial years post-diagnosis.
Aims:
Cardiovascular disease is a common complication in acromegaly. We investigated the risk of cardiovascular disease and mortality in patients with acromegaly in a large-scale population using nationwide data in Korea.
Methods And Results:
We performed a nationwide, retrospective, observational, cohort study of patients with acromegaly (n = 1874) and age- and sex-matched subjects without acromegaly (n = 9370) for a mean follow-up of 7.5 ± 3.2 years. The study outcomes were myocardial infarction, stroke, atrial fibrillation, congestive heart failure, and all-cause death. All outcomes were analysed by Cox proportional hazards regression analysis while controlling for age, sex, household income, place, Type 2 diabetes, hypertension, and dyslipidaemia. The incidence (per 1000 person-years) of atrial fibrillation (3.06 vs. 1.70; P = 0.001), congestive heart failure (3.11 vs. 1.63; P < 0.001), and all-cause mortality (6.31 vs. 4.03; P < 0.001) in patients with acromegaly was higher than in controls. However, the incidence of myocardial infarction and stroke did not differ between groups. After adjustment for covariates, the risk for atrial fibrillation [hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.09-2.31], congestive heart failure (HR: 1.54; 95% CI: 1.06-2.25), and all-cause mortality (HR: 1.31; 95% CI: 1.01-1.69) was significantly higher in patients with acromegaly. In time lag sensitivity analysis, a higher risk for atrial fibrillation was observed only in the first 4 years after diagnosis in acromegaly patients compared with controls (HR: 3.05; 95% CI: 1.94-4.79).
Conclusion:
Patients with acromegaly were at higher risk for atrial fibrillation, congestive heart failure, and all-cause death. The risk of atrial fibrillation had a time-dependent association with acromegaly.
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