Amelioration of cardiovascular risk factors with partial biochemical control of acromegaly.
OBJECTIVE
Complete remission of acromegaly is associated with favourable changes in cardiovascular risk parameters. We evaluated the effects of suboptimal therapy on haemodynamic, metabolic, inflammatory and coagulation cardiovascular risk indices.


METHODS
Eighteen acromegalic patients on somatostatin analogues, with incomplete biochemical control, were evaluated at diagnosis and 6 months after treatment and compared to 15 healthy age- and body mass index (BMI)-matched controls. Measurements of blood pressure, GH, IGF-I, glucose, insulin, glycated haemoglobin (HbA1c), lipids, apolipoprotein A1 (apoA1), apoB, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA) and circulating thrombomodulin were performed in all study participants, followed by an oral glucose tolerance test (OGTT). Insulin sensitivity (IS) was expressed by the Matsuda index (OGTT(ISI)).


RESULTS
Partial control of acromegaly resulted in a significant reduction in systolic and diastolic blood pressure, glucose, insulin, HbA1c, total (T-C) and low density lipoprotein cholesterol (LDL-C) and triglyceride levels, and a significant increase in apoA1, high density lipoprotein cholesterol (HDL-C) and OGTT(ISI) compared to pretreatment levels. Plasma fibrinogen and PAI-1 levels fell significantly [respectively (mean +/- SEM), 11.04 +/- 0.41 vs. 10.12 +/- 0.34 micromol/l, P = 0.003 and 9.6 +/- 1.97 vs. 6.55 +/- 1.89 microg/l, P < 0.001]. However, a marked reduction in tPA [median (IQR) 5.1 (2.5-15) vs. 3.4 (2.4-8.6) microg/l, P = 0.031] and an increase in hs-CRP [median (IQR) 0.05 (0.03-0.11) vs. 0.1 (0.06-0.23) mg/l, P < 0.001] were also noted. On treatment, acromegalic patients were comparable to controls, except for OGTT(ISI), lipoprotein(a) [Lp(a)], fibrinogen and tPA and HDL-C levels. Thrombomodulin and apoB levels were not affected by treatment.


CONCLUSIONS
Partial control in disease activity following somatostatin analogues results in significant improvement in a considerable number of cardiovascular risk markers in acromegaly.
Delaroudis
Sideris P
SP
Endocrine Clinic, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
Efstathiadou
Zoe A
ZA
Koukoulis
George N
GN
Kita
Marina D
MD
Farmakiotis
Dimitrios
D
Dara
Ourania G
OG
Goulis
Dimitrios G
DG
Makedou
Areti
A
Makris
Pantelis
P
Slavakis
Aris
A
Avramides
Avraam I
AI
D000172:Acromegaly / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D003692:Delayed-Action Preparations; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006727:Hormone Antagonists / Q000008:administration & dosage; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D012307:Risk Factors; D013004:Somatostatin / Q000031:analogs & derivatives; D017211:Treatment Failure
D015415:Biomarkers; D003692:Delayed-Action Preparations; D006727:Hormone Antagonists; D013004:Somatostatin; D015282:Octreotide