Adult patients with congenital adrenal hyperplasia have elevated blood pressure but otherwise a normal cardiovascular risk profile
Christiaan Mooij, Jeanne Margot Kroese, Fred Sweep, Ad Hermus & Cees Tack
Objective: Treatment with glucocorticoids and mineralocorticoids has changed congenital adrenal hyperplasia (CAH) from a fatal to a chronic lifelong disease. As a result of long-term treatment, including chronic (over-)treatment with glucocorticoids, patients with CAH may develop an adverse cardiovascular risk profile. The objective of this study was to evaluate the cardiovascular risk profile of adult CAH patients.
Patients and measurements: In this casecontrol study the cardiovascular risk profile of 27 adult CAH patients and 27 controls, matched for age, gender and body mass index was evaluated by measuring ambulatory 24-h blood pressure, insulin sensitivity (HOMA-IR), lipid profiles, albuminuria and circulating cardiovascular risk markers (PAI-1, tPA, uPA, tPA/PAI-1 complex, hsCRP, adiponectin, IL6, IL18, and leptin).
Results: Twenty-four-hour systolic (126.3 mmHg±15.5 vs 124.8 mmHg±15.1 in controls, P=0.019) and diastolic (76.4 mmHg±12.7 vs 73.5 mmHg±12.4 in controls, P<0.001) blood pressure was significantly elevated in CAH patients compared to the control population. CAH patients had higher HDL cholesterol levels (P<0.01), lower hsCRP levels (P=0.03) and there was a trend toward elevated adiponectin levels compared to controls. Other cardiovascular risk factors were similar in both groups. Average BMI was high in CAH patients (27.2±4.6 kg/m2). It was not possible to evaluate BMI as an individual cardiovascular risk marker because controls were matched for BMI.
Conclusion: Adult CAH patients have higher ambulatory blood pressure compared to age, gender and body mass matched controls, which may be related to glucocorticoid and mineralocorticoid treatment. Average body mass was high. Other cardiovascular risk markers did not differ, while HDL-cholesterol, hsCRP and adiponectin levels tended to be more favourable.