Cardiomyopathy in Patients With Acromegaly - Not Truly a Concern Anymore?

Area of Science:

• Endocrinology
• Cardiology
• Internal Medicine

Background:

• Acromegaly, caused by excessive growth hormone (GH) and insulin-like growth factor-I (IGF-I), historically led to high mortality, primarily due to cardiovascular and metabolic issues.
• Cardiovascular comorbidities were considered the leading cause of death in acromegaly patients.

Purpose of the Study:

• To review the impact of GH/IGF-I excess and its treatment on cardiovascular risk factors.
• To analyze morphological and functional cardiac changes in acromegaly patients.
• To discuss evolving prevalence rates of cardiac manifestations over time.

Main Methods:

• Review of existing literature on acromegaly, GH/IGF-I excess, and cardiovascular outcomes.
• Analysis of studies examining cardiac morphology and function using various imaging techniques.
• Epidemiological data analysis on mortality and heart failure risk.

Main Results:

• While morphological cardiac changes like myocardial hypertrophy and chamber enlargement are common in acromegaly, clinically significant dysfunction is infrequent.
• Valvular heart disease and arrhythmias are noted, but clinically relevant cardiomyopathy is less prevalent than previously thought.
• Recent data indicate that the risk of heart failure in treated acromegaly patients is similar to that of the general population, considering disease control and other risk factors.

Conclusions:

• Advances in GH/IGF-I-lowering therapies and improved management of risk factors have substantially reduced mortality in acromegaly.
• Overt cardiac dysfunction and clinically significant cardiomyopathy are less common in acromegaly than historical estimates suggest.
• Effective management of acromegaly leads to cardiovascular risk profiles comparable to the general population.