Acromegaly and coronary disease: an integrated evaluation of conventional coronary risk factors and coronary calcifications detected by computed tomography.
BACKGROUND
Coronary atherosclerosis in acromegaly was not extensively investigated in the literature until now. At autopsy, it was demonstrated in about 20% of patients with long-lasting disease, and myocardial infarction was reported as cause of death in a quarter of acromegalics.


OBJECTIVE
The objective of the study was to evaluate coronary atherosclerosis in a cohort of acromegalics with controlled or uncontrolled disease.


METHODS
Coronary risk was evaluated by the Framingham algorithm, according to the Framingham score (FS). Patients were stratified into low (<6%), intermediate (6-20%), and high (>20%) midterm risk. Coronary calcium deposits were detected by multidetector computed tomography and measured by the Agatston algorithm. Coronary artery calcium [Agatston score (AS)] was quantified at the level of left main artery, left anterior descendent artery, left circumflex artery, right coronary artery, and posterior descendent artery. Total AS values in healthy persons are less than 50 (aged < 60 yr) and less than 300 (age > or = 60 yr).


METHODS
Thirty-nine patients (12 males and 27 females, aged 53.0 +/- 2.1 yr) were evaluated. In each patient, the mean of at least four determinations of serum IGF-I, assayed during the last 2 yr before study, was normalized for the age-matched normal range, and the result was presented as sd value (IGF-I sd). On the basis of serum IGF-I sd, acromegaly was considered controlled (< or =1.9 sd; n = 24) or uncontrolled (> or = 2.0 sd; n = 15).


RESULTS
The FS was intermediate in 12 and high in two acromegalics. Overall, the FS was not correlated with serum GH values and IGF-I sd. Mean FS was not significantly different between patients with controlled and uncontrolled acromegaly. Total AS was increased in nine patients, most frequently in left anterior descendent, left circumflex, and left main arteries. In these nine patients, mean AS was similar in individuals with controlled and those with uncontrolled acromegaly, and the rate of 17% patients with controlled disease having increased AS was not statistically different from the rate of 33% uncontrolled acromegalics. Total AS was increased in six of 12 males and in three of 27 females (chi(2) 7.1, P < 0.01). Overall, total AS correlated with FS (r(2) = 0.4, P < 0.0002) but not age, body mass index, disease duration, indexed left ventricular mass, serum cholesterol, triglycerides, GH, or IGF-I levels. Increased AS was more frequently observed in acromegalics with diabetes mellitus (chi(2) = 5.2, P < 0.05) or hypertension (chi(2) = 9.8, P < 0.002) but not in smokers (chi(2) = 1.34, P = NS). Seven of nine patients with coronary calcium deposits had a FS greater than 6%. In six of 13 patients with FS greater than 6%, multidetector computed tomography did not demonstrate coronary calcifications.


CONCLUSIONS
In our study, the integrated evaluation of FS and AS showed that 41% of acromegalics are at risk for coronary atherosclerosis and that coronary calcifications were evident in about half of them despite the fact that myocardial infarction was not more frequent in acromegalic patients than the general population. Moreover, the control of acromegaly did not influence significantly the extent of coronary atherosclerosis.
Cannavo
Salvatore
S
Sezione di Endocrinologia, Pad. H, piano 4 Azienda Ospedaliera Universitaria Policlinico G. Martino, Via Consolare Valeria 1, 98125 Messina, Italy. cannavos@unime.it
Almoto
Barbara
B
Cavalli
Giovanni
G
Squadrito
Stefano
S
Romanello
Giovanni
G
Vigo
Maria Teresa
MT
Fiumara
Francesco
F
Benvenga
Salvatore
S
Trimarchi
Francesco
F
D000172:Acromegaly / Q000150:complications*; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003324:Coronary Artery Disease / Q000209:etiology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I