Background: Acromegaly is associated with increased morbidity and mortality from cardiovascular disease. Several studies indicate that reduction of growth hormone (GH) to <1 μg/l or normalization of serum IGF-I reduces mortality to expected levels. Inflammatory markers, such as C-reactive protein (CRP) or haemostatic markers, such as fibrinogen have emerged as important cardiovascular risk markers in the general population.
Objective and design: The objective of the present study was to assess serum levels of high sensitive CRP and fibrinogen in patients with normalized GH and IGF-1 values after treatment compared to the background population. This case-control study included 32 patients (18 women) with acromegaly after successful treatment and 128 controls of a population-based study matched by sex and age.
Results: We detected a higher body mass index (30.3 vs 27.2 kg/m2; P=0.02) and more cases of diabetes (23 vs 9%; P=0.05) in patients with acromegaly compared to controls. However, there was no differences for hypertension, smoking and lipids between both groups. Patients revealed normalized but even higher mean IGF-1 values than controls (129.5 vs 232.7 ng/ml; P<0.05). Moreover, patients with acromegaly showed higher values of high sensitive CRP and fibrinogen. After adjustment for confounders, patients with acromegaly had higher odds of serum CRP and fibrinogen values compared to controls. In a linear regression model, elevated fibrinogen values were positive associated with IGF-1 values and acromegaly.
Conclusion: Normalized but higher IGF-1 values after treatment of acromegaly are associated with increased high sensitive CRP or fibrinogen values. This might be a possible explanation for the revealed increased all-cause mortality in acromegalic patients compared to the general population even after treatment.