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Cardiovascular health and mortality in Cushing's disease
Amy Coulden1,2,3, Ross Hamblin1,2,3, John Wass4
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Insights
Cushing's disease (CD) causes significant cardiovascular risks, including heart attack and stroke, even after treatment. Long-term monitoring and management are crucial for patients with CD due to lasting cardiovascular effects.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
Background:
- Cushing's disease (CD) is characterized by cortisol excess, leading to severe cardiovascular morbidity and mortality.
- Many CD patients present with pre-existing cardiovascular risk factors like obesity, diabetes, hypertension, and dyslipidemia.
Purpose of the Study:
- To highlight the persistent cardiovascular risks in Cushing's disease patients, even after achieving hypercortisolemia remission.
- To emphasize the need for comprehensive cardiovascular management throughout the patient care continuum.
Main Methods:
- Review of clinical data and outcomes in patients with Cushing's disease.
- Analysis of cardiovascular morbidity and mortality rates in relation to hypercortisolemia status and remission duration.
Main Results:
- Hypercortisolemia in CD significantly increases cardiovascular disease risk, a leading cause of death.
- While remission reduces complications, long-term monitoring reveals persistent high risks for myocardial infarction and stroke.
- A multicenter study indicated increased all-cause and circulatory mortality in patients with CD in remission for over 10 years.
Conclusions:
- Cardiovascular complications in Cushing's disease have long-lasting effects, underscoring the importance of early diagnosis and effective treatment.
- Ongoing cardiovascular monitoring and management are essential for Cushing's disease patients, from initial diagnosis through long-term follow-up.
Abstract:
Exposure to cortisol excess in Cushing's disease (CD) results in increased cardiovascular morbidity and reduces survival, with cardiovascular disease being a leading cause of death. At diagnosis, a significant number of patients have adverse cardiovascular profiles (e.g., obesity, diabetes or impaired glucose tolerance, dyslipidemia, hypertension, cardiac abnormalities and vascular disease). Remission of hypercortisolemia reduces but does not completely eliminate the cardiovascular complications; hazard ratios for myocardial infarction and stroke are high during long-term monitoring, highlighting the long-lasting effects of hypercortisolism and the importance of the timely diagnosis and successful management of this condition. Data on mortality of patients in remission are not consistent but in a multicenter study, an increased all-cause and circulatory mortality in patients with CD in remission for at least 10 years has been demonstrated. Cardiovascular morbidity requires particular focus and effective management during the care of patients with CD, from their presentation until long-term follow up.
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