Structural and functional carotid wall alterations in controlled versus active acromegaly
Simona Galoiu1,2, Ruxandra Jurcut1,3, Aurora Vladaia3, Oana Savu3, Ionela Baciu1, Mariana Purice2, Carmen Ginghina1,3 & Mihail Coculescu1,2
The structural and functional effects upon arterial vessels of GH and IGF1, chronically elevated in active acromegaly, are risk factors for premature atherosclerosis, but current therapies can normalize GH and IGF1 production.
Aims: To evaluate if carotid wall alterations in acromegaly are reversible after disease control.
Material and methods: Fifteen patients with controlled acromegaly (CA) after multimodal therapy (45.5±11.4 years) were compared with 30 patients with active acromegaly (AA) (49.6±9.9 years) and a control group of 21 age-, sex- and risk factors-matched patients without acromegaly (W) (40.7±11.8 years) using right common carotid echography, studying both structural (carotid diameter, intima-media thickness index IMT), and functional parameters (augmentation index, arterial compliance and local pulse wave velocity PWV) with e-tracking.
Results: The estimated acromegaly duration was 12.3±8.4 years and the disease free interval in CA group was 0.7±1.5 years. There were no significant differences between disease duration, sex distribution, age, high blood pressure or diabetes mellitus prevalence in studied groups.
All patients with acromegaly showed structural changes of carotid artery: higher diameters (6.3±0.5 mm) and IMT (0.7±0.1 mm) versus control (5.7±0.6 mm and 0.5±0.1 mm, respectively), P<0.01. IMT, a marker of subclinical atherosclerosis, was dependent on age (r=0.3, P=0.02), systolic blood pressure (r=0.3, P=0.04) and disease duration (r=0.3, P=0.05). Carotid diameter and IMT did not differ between CA and AA, irrespective of the type of therapy.
The functional test PWV was significantly higher in CA group vs. controls (6.4±1.3 m/s vs 5.4±0.7 m/s, P=0.001) and not different from AA group (6.8±1.6 m/s).
Conclusions: Structural and functional alterations of the carotid in acromegaly were not improved after six months of GH and IGF1 normalization. A longer disease free interval would establish if these modifications are truly irreversible in the long-term.