title: Hypercortisolism is associated with increased coronary arterial atherosclerosis: analysis of noninvasive coronary angiography using multidetector computerized tomography.
abstract: BACKGROUND
  Observational studies show that glucocorticoid therapy and the endogenous hypercortisolism of Cushing's syndrome (CS) are associated with increased rates of cardiovascular morbidity and mortality. However, the causes of these findings remain largely unknown.
  
  
  OBJECTIVE
  To determine whether CS patients have increased coronary atherosclerosis.
  
  
  METHODS
  A prospective case-control study was performed.
  
  
  METHODS
  Subjects were evaulated in a clinical research center.
  
  
  METHODS
  Fifteen consecutive patients with ACTH-dependent CS, 14 due to an ectopic source and 1 due to pituitary Cushing's disease were recruited. Eleven patients were studied when hypercortisolemic; 4 patients were eucortisolemic due to medication (3) or cyclic hypercortisolism (1). Fifteen control subjects with at least one risk factor for cardiac disease were matched 1:1 for age, sex, and body mass index.
  
  
  METHODS
  Agatston score a measure of calcified plaque and non-calcified coronary plaque volume were quantified using a multidetector CT (MDCT) coronary angiogram scan. Additional variables included fasting lipids, blood pressure, history of hypertension or diabetes, and 24-hour urine free cortisol excretion.
  
  
  RESULTS
  CS patients had significantly greater noncalcified plaque volume and Agatston score (noncalcified plaque volume [mm(3)] median [interquartile ranges]: CS 49.5 [31.4, 102.5], controls 17.9 [2.6, 25.3], P < .001; Agatston score: CS 70.6 [0, 253.1], controls 0 [0, 7.6]; P < .05). CS patients had higher systolic and diastolic blood pressures than controls (systolic: CS 143 mm Hg [135, 173]; controls, 134 [123, 136], P < .02; diastolic CS: 86 [80, 99], controls, 76 [72, 84], P < .05).
  
  
  CONCLUSIONS
  Increased coronary calcifications and noncalcified coronary plaque volumes are present in patients with active or previous hypercortisolism. Increased atherosclerosis may contribute to the increased rates of cardiovascular morbidity and mortality in patients with glucocorticoid excess.
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Neary
authors.forename: O Julian
authors.initials: OJ
authors.lastname: Booker
authors.forename: Brent S
authors.initials: BS
authors.lastname: Abel
authors.forename: Jatin R
authors.initials: JR
authors.lastname: Matta
authors.forename: Nancy
authors.initials: N
authors.lastname: Muldoon
authors.forename: Ninet
authors.initials: N
authors.lastname: Sinaii
authors.forename: Roderic I
authors.initials: RI
authors.lastname: Pettigrew
authors.forename: Lynnette K
authors.initials: LK
authors.lastname: Nieman
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Gharib
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D003480:Cushing Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000209:etiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000209:etiology
chemical_list: D006854:Hydrocortisone
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