Prevalence and Characteristics of Heart Disease in Patients with Acromegaly in Colombia (RAPACO HEART Study)
Alin Abreu-Lomba1, David Aristizábal-Colorado2, Santiago Sierra-Castillo3
1Department of Endocrinology, Imbanaco Clinic, Interinstitutional Group of Internal Medicine (GIMI1), Universidad Libre, Cali, Colombia.
Insights
Acromegalic heart disease (AHD) affects over 30% of patients with acromegaly in Colombia. Carpal tunnel syndrome is a significant predictor of AHD, highlighting the need for cardiovascular monitoring.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Acromegaly, a disorder of excessive growth hormone (GH) and insulin-like growth factor 1 (IGF-1) secretion, leads to multisystemic complications.
- Cardiovascular complications are prevalent in acromegaly, affecting up to 80% of patients and posing a significant health concern.
Purpose of the Study:
- To determine the prevalence of acromegalic heart disease (AHD) in a Colombian population.
- To identify factors associated with the development of AHD in patients with acromegaly.
Main Methods:
- A retrospective, multicenter case-control study utilizing data from the RAPACO registry.
- Inclusion criteria: patients aged 16+ with confirmed acromegaly and available echocardiogram.
- AHD definition: structural or functional cardiac abnormalities linked to acromegaly.
Main Results:
- Out of 193 acromegaly patients, 61 (31.6%) had AHD.
- AHD patients were older, had larger abdominal perimeters, and longer diagnostic delays.
- Left ventricular hypertrophy was the most common finding (52.4%), followed by biventricular hypertrophy (19.7%).
- Carpal tunnel syndrome (OR 3.81) and hypertension (OR 1.75) were independently associated with AHD.
Conclusions:
- Acromegalic heart disease remains a common complication in Colombian patients with acromegaly.
- Carpal tunnel syndrome, hypertension, arrhythmias, and diabetes are linked to AHD.
- Proactive cardiovascular screening and management are crucial for patients with acromegaly.
Introduction:
Acromegaly is a chronic disorder characterized by excessive secretion of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), resulting in multisystem involvement. Cardiovascular complications affect up to 80% of cases and represent a major concern in advanced stages of the disease. This study aimed to determine the prevalence of acromegalic heart disease (AHD) and identify factors associated with its development in a Colombian population.
Methods:
A retrospective, multicenter case-control study was carried out using data from the national RAPACO registry. Patients aged 16 years or older with confirmed acromegaly and an available echocardiogram were included. AHD was defined by structural or functional cardiac abnormalities attributable to acromegaly.
Results:
A total of 193 patients with acromegaly were analyzed; 61 (31.6%) had AHD. Compared with the non-AHD group, these patients were older, had a 4.5 cm larger abdominal perimeter, and had a median time from disease onset to diagnosis of 8 years (vs. 6 years in those without AHD). Among the 61 AHD cases, the most frequent finding was isolated left ventricular hypertrophy (n = 32, 52.4%), followed by biventricular hypertrophy (n = 12, 19.7%), valvulopathy (n = 4, 6.6%), and combined LVH with valvulopathy (n = 4, 6.6%). GH and IGF-1 levels were modestly higher in AHD patients. In multivariate analysis, hypertension (HTN) showed an odds ratio (OR) of 1.75 (95% CI: 0.67-4.65) for AHD, while carpal tunnel syndrome significantly increased the odds of AHD (OR 3.81, p = 0.01, 95% CI: 1.36-11.14).
Conclusions:
Despite therapeutic advances, AHD remains common in Colombian patients with acromegaly. Notably, carpal tunnel syndrome was independently associated with AHD, alongside HTN, arrhythmias, and type 2 diabetes mellitus. These findings underscore the need for proactive cardiovascular screening and management strategies in this patient population.
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