Acromegaly and coronary disease: an integrated evaluation of conventional coronary risk factors and coronary calcifications detected by computed tomography.

CONTEXT Coronary atherosclerosis in acromegaly was not extensively investigated in the literature until now. At autopsy, it was demonstrated in about 20% of patients with long-lasting disease, and myocardial infarction was reported as cause of death in a quarter of acromegalics. OBJECTIVE The objective of the study was to evaluate coronary atherosclerosis in a cohort of acromegalics with controlled or uncontrolled disease. DESIGN Coronary risk was evaluated by the Framingham algorithm, according to the Framingham score (FS). Patients were stratified into low (<6%), intermediate (6-20%), and high (>20%) midterm risk. Coronary calcium deposits were detected by multidetector computed tomography and measured by the Agatston algorithm. Coronary artery calcium [Agatston score (AS)] was quantified at the level of left main artery, left anterior descendent artery, left circumflex artery, right coronary artery, and posterior descendent artery. Total AS values in healthy persons are less than 50 (aged < 60 yr) and less than 300 (age > or = 60 yr). PATIENTS Thirty-nine patients (12 males and 27 females, aged 53.0 +/- 2.1 yr) were evaluated. In each patient, the mean of at least four determinations of serum IGF-I, assayed during the last 2 yr before study, was normalized for the age-matched normal range, and the result was presented as sd value (IGF-I sd). On the basis of serum IGF-I sd, acromegaly was considered controlled (< or =1.9 sd; n = 24) or uncontrolled (> or = 2.0 sd; n = 15). RESULTS The FS was intermediate in 12 and high in two acromegalics. Overall, the FS was not correlated with serum GH values and IGF-I sd. Mean FS was not significantly different between patients with controlled and uncontrolled acromegaly. Total AS was increased in nine patients, most frequently in left anterior descendent, left circumflex, and left main arteries. In these nine patients, mean AS was similar in individuals with controlled and those with uncontrolled acromegaly, and the rate of 17% patients with controlled disease having increased AS was not statistically different from the rate of 33% uncontrolled acromegalics. Total AS was increased in six of 12 males and in three of 27 females (chi(2) 7.1, P < 0.01). Overall, total AS correlated with FS (r(2) = 0.4, P < 0.0002) but not age, body mass index, disease duration, indexed left ventricular mass, serum cholesterol, triglycerides, GH, or IGF-I levels. Increased AS was more frequently observed in acromegalics with diabetes mellitus (chi(2) = 5.2, P < 0.05) or hypertension (chi(2) = 9.8, P < 0.002) but not in smokers (chi(2) = 1.34, P = NS). Seven of nine patients with coronary calcium deposits had a FS greater than 6%. In six of 13 patients with FS greater than 6%, multidetector computed tomography did not demonstrate coronary calcifications. CONCLUSIONS In our study, the integrated evaluation of FS and AS showed that 41% of acromegalics are at risk for coronary atherosclerosis and that coronary calcifications were evident in about half of them despite the fact that myocardial infarction was not more frequent in acromegalic patients than the general population. Moreover, the control of acromegaly did not influence significantly the extent of coronary atherosclerosis.

[1]  M. Dewey Coronary angiography with multislice computed tomography. , 2005, JAMA.

[2]  L. Niskanen,et al.  A nationwide survey of mortality in acromegaly. , 2005, The Journal of clinical endocrinology and metabolism.

[3]  P. Velasco,et al.  Angiografía coronaria mediante tomografía computarizada multicorte , 2005 .

[4]  Richard D. White,et al.  CT of the heart: principles, advances, clinical uses. , 2005, Cleveland Clinic journal of medicine.

[5]  Michael Pignone,et al.  Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. , 2004, Archives of internal medicine.

[6]  P. Marzullo,et al.  Systemic complications of acromegaly: epidemiology, pathogenesis, and management. , 2004, Endocrine reviews.

[7]  M. Reiser,et al.  CT measurement of coronary calcium mass: impact on global cardiac risk assessment , 2004, European Radiology.

[8]  P. Greenland,et al.  Clinical practice. Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing. , 2003, The New England journal of medicine.

[9]  R. Clayton Cardiovascular function in acromegaly. , 2003, Endocrine reviews.

[10]  H. Hecht,et al.  Evaluation by electron beam tomography of changes in calcified coronary plaque in treated and untreated asymptomatic patients and relation to serum lipid levels. , 2003, American Journal of Cardiology.

[11]  S. Achenbach,et al.  Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification: A Prospective Evaluation , 2002, Circulation.

[12]  P. Marzullo,et al.  Effect of a six-month treatment with lanreotide on cardiovascular risk factors and arterial intima-media thickness in patients with acromegaly. , 2002, European journal of endocrinology.

[13]  Y. Saitoh,et al.  Characterization of premature atherosclerosis of carotid arteries in acromegalic patients , 2001, Clinical endocrinology.

[14]  Matthijs Oudkerk,et al.  Coronary angiography with multi-slice computed tomography , 2001, The Lancet.

[15]  H. Hecht,et al.  Relation of coronary artery calcium identified by electron beam tomography to serum lipoprotein levels and implications for treatment. , 2001, The American journal of cardiology.

[16]  R. McNally,et al.  Mortality and Cancer Incidence in Acromegaly: A Retrospective Cohort Study , 1998 .

[17]  W. Edwards,et al.  Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. , 1998, Journal of the American College of Cardiology.

[18]  J. Rumberger,et al.  Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. , 1995, Circulation.

[19]  A. Barkan Acromegaly , 1890, Trends in Endocrinology & Metabolism.

[20]  R. Detrano,et al.  Quantification of coronary artery calcium using ultrafast computed tomography. , 1990, Journal of the American College of Cardiology.

[21]  J. Lie,et al.  Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. , 1980, American heart journal.