Impact of Medical Therapies on Cardiovascular Risk Factors in Acromegaly

Acromegaly results from excess growth hormone production and has a significant burden of cardiovascular comorbidities. Various medical therapies have been shown to be efficacious in achieving disease control along with surgery and radiotherapy. However, the impact of these medical therapies on cardiovascular risk factors remains unclear. The overall objective of this review was to assess the impact of various medical therapies used for acromegaly on blood pressure, glucose metabolism, left ventricular mass, and lipid profile. A systematic narrative synthesis was conducted in accordance with PRISMA recommendations (PROSPERO registration number CRD42024609974). A comprehensive search of electronic databases was conducted in MEDLINE, OVID, ProQuest Central, Scopus, and Web of Science. The search covered studies published in English over the last 20 years on acromegaly medical treatments and cardiovascular risk factors. The review included randomized control trials, non-randomized control trials, case-control studies, and cohort studies. Only original before-and-after treatment studies assessing systolic and diastolic blood pressure, fasting plasma glucose, HbA1c, left ventricular mass, and lipid profiles were selected. Reviews, case reports, uncontrolled trials, and studies addressing other cardiometabolic parameters were excluded. To evaluate the methodological quality of the included studies, the risk of bias was assessed using the standardized critical appraisal tools developed by the Joanna Briggs Institute (JBI). A total of 4777 articles were retrieved, out of which 20 met the inclusion criteria for the qualitative analysis after data extraction. The growth hormone receptor blocker pegvisomant was associated with a significant post-treatment reduction in both fasting plasma glucose and HbA1c. The long-acting somatostatin receptor ligand pasireotide, on the other hand, was associated with an increase in these glucose parameters. All the medical therapies were associated with a decrease in left ventricular mass when disease control was achieved over a sufficient period. A significant reduction in lipid parameters was also observed in patients treated with somatostatin receptor ligands. However, the impact of these agents on blood pressure control was confounded by concurrent antihypertensive therapies.