Risk of cerebrovascular and cardiovascular events in acromegaly: a systematic review and meta-analysis

BACKGROUND: Acromegaly is a rare endocrine disorder marked by chronic excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), which is associated with significant cardiovascular and cerebrovascular remodeling. While cardiovascular disease has long been the main cause of mortality, contemporary vascular risk remains unclear. This systematic review and meta-analysis quantified cerebrovascular and cardiovascular event risk in acromegaly versus the general population or matched controls. METHODS: We searched Databases up to September 2025 for cohort, case–control, cross-sectional, randomized, and registry-based studies reporting vascular outcomes in adults with acromegaly. Outcomes included heart failure, myocardial infarction, stroke, arrhythmias, valvular disease, cerebral aneurysm, vascular mortality, and venous thromboembolism. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using random-effects meta-analysis. RESULTS: Eight studies (n ≈ 5,800 patients) were included. Acromegaly was associated with a significantly increased risk of heart failure (generic ratio effect of 1.82, 95% CI 1.17–2.83) and atrial fibrillation (generic ratio effect of 1.59, 95% CI 1.09–2.31). Risks of myocardial infarction (generic ratio effect of 0.91, 95% CI 0.65–1.28) and stroke (generic ratio effect of 1.10, 95% CI 0.80–1.53) were not significantly elevated. Additional outcomes included increased prevalence of valvular disease, left ventricular hypertrophy, cerebral aneurysm (in men), and venous thromboembolism. Evidence on cardiovascular mortality was mixed. CONCLUSION: Acromegaly is associated with a significantly increased risk of heart failure and atrial fibrillation. Additionally, individual studies suggest a higher prevalence of valvular disease, thromboembolic events, and cerebral aneurysms, though these findings require confirmation in larger cohorts. These findings highlight the need for tailored cardiovascular surveillance strategies in acromegaly.