Objectives: Acromegaly is associated with elevated cardiovascular morbidity. Medical treatment of acromegaly does not only lead to a normalisation of the somatotroph axis, but can also negatively influence cardiovascular risk factors and comorbidities.
Methods: In a cross-sectional study, we evaluated cardiovascular risk markers (glucose, HbA1c, triglycerides, cholesterol, HDL, LDL, lipoprotein a, homocystein, CRP) in relation to biochemical control and medical treatment modalities in 81 acromegalic patients treated at the Endocrine Outpatient Clinic of the Max Planck Institute of Psychiatry and the Department of Medicine (Innenstadt) of the Ludwig-Maximilians-University in Munich.
Results: Biochemically controlled acromegalics (n=47), compared to uncontrolled patients (n=34), had significantly elevated total (Mean 222.2±35.1 vs. 200.6±41.2 mg/dl; P=0.033) and LDL cholesterol levels (Mean 146.6±32.4 vs. 124.4±40.8 mg/dl; P=0.041) and lower homocystein levels (Mean 11.7±4.0 vs. 14.3±6.8 μmol/l; P=0.005), but no differences in glucose, HbA1c, HDL, triglycerides, lipoprotein a, and CRP. IGF-1 correlated positively with HbA1c (P=0.029), and GH nadir OGTT correlated positively with HbA1c (P=0.040), triglycerides (P=0.047), and lipoprotein a (P=0.016), but not with glucose, CRP, cholesterol, HDL, LDL or homocystein. Somatostatin analogue (SA, n=27) treatment in acromegalic patients was associated with lower total (Mean 192.8±30 vs. 219.0±40.2 mg/dl; P=0.016) and LDL cholesterol (Mean 119.3±25.6 vs. 143.4±38.7 mg/dl; P=0.016), but with elevated glucose (Mean 104.7±15.9 vs. 91.4±16.2 mg/dl; P=0.014) and HbA1c levels (Mean 5.9±0.5 vs. 5.6±0.4%; P=0.018) compared to patients not treated with SA. Finally, the pegvisomant treated group (n=10) had lower HbA1c levels compared to otherwise treated patients (Mean 5.5±0.3 vs. 5.7±0.5%; P=0.042).
Conclusions: Our results suggest that future treatment decisions should not only target biochemical control, but a thorough evaluation of long-term consequences on cardiovascular risks depending on the different acromegalic patient profiles should additionally guide the treatment algorithm.
03 - 07 May 2008
European Society of Endocrinology