Background: Increased cardiovascular mortality and evidence of atherosclerosis have been reported in patients with pituitary disorders, irrespective of type of pituitary hormone deficiency. However, there are few data on cardiovascular events in patients with secondary adrenal failure due to pituitary disease compared with those who have primary adrenal failure.
Subjects: 2052 patients with primary adrenal failure were compared with 20 366 matched controls and 3948 patients with secondary adrenal failure with 39 134 matched controls, in the UK general practitioner database (Clinical Practice Research Datalink; CPRD).
Methods: All participants were followed-up from one of the following: 1987, the date of diagnosis, the GP registration date, or the date at which GP provided standard information, whichever occurred latest. The end of follow-up was the first cardiovascular event, death, de-registering from the GP, or the end of 2017, whichever occurred earliest.
Results: With total follow-up times of 11 738 vs. 118 657 and 21 148 vs. 209 714 person-years for primary and secondary disease respectively, incidence rates relative to their controls (95%CI) for composite cardiovascular events were 26.8 (24.029.9) vs. 22.1 (21.323.0) and 32.8 (30.435.3) vs. 24.7 (24.025.4) per 1000 person-years. In primary adrenal failure, the adjusted HR (95%CI) was 1.08 (0.961.21) for composite cardiovascular events, 0.99 (0.831.19) for ischaemic heart disease, and 1.00 (0.801.25) for stroke. In secondary adrenal failure, the adjusted HR (95%CI) was 1.09 (1.011.19) for composite cardiovascular events, 0.91 (0.801.03) for ischaemic heart disease, and 1.53 (1.341.74) for stroke.
Conclusion: Cardiovascular events were increased relative to normal controls in patients with secondary but not primary adrenal failure. The increased rate was mainly due to increased stroke and not ischaemic heart disease. This study does not support the hypothesis that adrenal failure or its replacement play a significant role in the increased cardiovascular disease observed in people with pituitary disease.