Introduction: Increased cardiovascular risk in hypopituitary patients was first documented by Rosen in 1990. Subsequent studies confirmed increased prevalence of cardiovascular and cerebrovascular disease in these patients. The exact mechanism for this is unclear. There is no clear consensus on how best to quantify or predict cardiac risk in hypopituitarism. QRISK2 cardiovascular disease risk algorithm provides estimates of 10-year cardiovascular disease (CVD) risk in patients from different ethnic groups in England and Wales, based on information from a large primary care database. NICE recommend 10-year CVD risk at which lipid-lowering treatment should be offered is ≧10%.
Methods: A prospective audit was carried out on a cohort of 86 patients (49 male, 37 female; 2584 years old) with hypopituitarism, recruited from St Bartholomews Hospital. Clinical history, aetiology of hypopituitarism and cardiovascular risk factors were recorded, including: ethnicity, age, sex, smoking status, systolic blood pressure, ratio of total serum cholesterol:HDL cholesterol, BMI, T2DM and family history of CVD. QRISK2 scores were calculated, to evaluate the contribution of traditional risk factors.
Results: The median age of the cohort was 58 years. Causes of pituitary disease included 34 pituitary macroadenoma, comprising 15 non-functioning pituitary adenoma, and 13 due to other causes. 47 (54.7%; 31 male, 16 female) out of 86 patients had QRISK2 score ≧10% (defined as high-risk group). Of these, 34 had systolic BP >120 (29 known hypertensives), 14 had HbA1c >43 mmol/mol, 22 had BMI>30 and 16 had elevated TC:HDL-C (>4). Mean duration of follow-up since diagnosis of hypopituitarism was 19 years. To date, no history of IHD and only one case of TIA was reported in the high-risk group. By contrast, the low-risk group comprised 18 with systolic BP >120, 3 with HbA1c >43 mmol/mol and 13 with elevated TC:HDL-C.
Discussion: Hypopituitarism is associated with increased traditional cardiovascular risk factors, albeit in a small cohort of patients. These should provide a focus for prevention.