title: GH levels and insulin sensitivity are differently associated with biomarkers of cardiovascular disease in active acromegaly.
abstract: BACKGROUND
  Acromegaly is characterized by GH excess and insulin resistance. It is not known which of these disorders is responsible for the increased atherogenic risk in these patients.
  
  
  OBJECTIVE
  To analyse the associations of GH and homoeostasis model assessment (HOMA) with biomarkers of cardiovascular disease and to compare the above-mentioned variables between patients with active acromegaly and controls.
  
  
  METHODS
  This open cross-sectional study was conducted at a University Hospital.
  
  
  METHODS
  Twenty-two outpatients were compared with sex- and age-matched control subjects.
  
  
  RESULTS
  Included clinical features, hormonal status, markers of insulin resistance, lipoprotein profile and biomarkers of cardiovascular disease.
  
  
  RESULTS
  Patients presented higher triglyceride (median [IQR]) (1·2[1·1-1·6] vs 0·9[0·6-1·1] mm, P < 0·05), low-density lipoprotein-cholesterol (LDL-C) (mean ± SD) (3·5 ± 0·9 vs 3·0 ± 0·7mm, P < 0·05), apoB (0·98 ± 0·23 vs 0·77 ± 0·22 g/l, P < 0·05), free fatty acid (0·69 ± 0·2 vs 0·54 ± 0·2 mM, P < 0·05), oxidized-LDL (120 ± 22 vs 85 ± 19 U/l, P < 0·05) and endothelin-1 (0·90 ± 0·23 vs 0·72 ± 0·17 ng/l, P < 0·05) levels, increased cholesteryl ester transfer protein (CETP) activity (179 ± 27 vs 138 ± 30%/ml/h, P < 0·01) and lower C reactive protein (CRP) (0·25[0·1-0·9] vs 0·85[0·4-1·4] mg/l; P < 0·05) levels than control subjects. Vascular cell adhesion molecule (VCAM-1) concentration was not different. By multiple linear regression analyses, HOMA explained the variability of triglycerides (25%), high-density lipoprotein-cholesterol (HDL-C) (30%) and CETP activity (28%), while GH independently predicted LDL-C (18%), oxidized-LDL (40%) and endothelin-1 levels (19%).
  
  
  CONCLUSIONS
  In patients with active acromegaly, GH excess contributes to the development of insulin resistance, and the interaction between both disturbances would be responsible for the appearance of atherogenic pro-oxidative and pro-inflammatory factors. Insulin resistance would be preferably associated with an atherogenic lipoprotein profile and to high CETP activity, while high GH levels would independently predict the increase in LDL-C, ox-LDL and endothelin-1.
authors.affiliation: Department of Clinical of Biochemistry, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, INFIBIOC, CONICET, Buenos Aires, Argentina. laura.boero@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Boero
authors.forename: M
authors.initials: M
authors.lastname: Manavela
authors.forename: T
authors.initials: T
authors.lastname: Meroño
authors.forename: P
authors.initials: P
authors.lastname: Maidana
authors.forename: L
authors.initials: L
authors.lastname: Gómez Rosso
authors.forename: F
authors.initials: F
authors.lastname: Brites
mesh_terms: D000172:Acromegaly / Q000097:blood* / Q000378:metabolism; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers; D013006:Growth Hormone