title: Three noninvasive methods in the evaluation of subclinical cardiovascular disease in patients with acromegaly: epicardial fat thickness, aortic stiffness and serum cell adhesion molecules.
abstract: BACKGROUND
  Several studies have reported increased risk of cardiovascular disease due to early development of endothelial dysfunction and structural vascular changes in patients with acromegaly.
  
  
  OBJECTIVE
  The aim of this study was to evaluate subclinical cardiovascular disease with epicardial fat thickness (EFT), aortic stiffness and serum levels of cell adhesion molecules (CAMs) in patients with acromegaly.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Twenty-seven patients with active acromegaly (AA), 13 patients with remission acromegaly (RA) and 37 age- and sex-matched healthy controls were studied.
  
  
  METHODS
  Epicardial fat thickness was evaluated by transthoracic echocardiography (TTE). Aortic stiffness (β) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by TTE. Serum levels of CAMs such as intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and E-selectin were measured.
  
  
  RESULTS
  Epicardial fat thickness was significantly increased in patients with RA and AA as compared to controls 9·71 ± 1·54 and 10·08 ± 1·95 mm vs 5·74 ± 0·92 mm, P < 0·001, respectively). A significant positive correlation was found between the EFT and growth hormone (GH) levels (r = 0·365, P = 0·024). β-index was similarly higher in patients with RA and AA than controls (15·68 ± 7·27 and 11·90 ± 8·24 vs 6·85 ± 2·87, P < 0·001, respectively). AoS and AoD were significantly decreased in patients with RA and AA as compared to the control group (3·81 ± 1·94 and 3·68 ± 1·99 vs 8·19 ± 4·19%, P < 0·001, respectively; and 1·21 ± 0·66 and 1·18 ± 0·63 vs 2·58 ± 1·50, 10(-6) cm(2) /dyn, P < 0·001, respectively). Serum ICAM-1 and VCAM-1 levels were significantly higher in patients as compared to the control group (P < 0·001 vs P = 0·032, respectively). There were no significant differences in EFT, AoD, AoS, β-index and serum CAMs between two patients groups (AA vs RA, P > 0·05). There was a significant negative correlation between E-selectin and AoD (r = -0·45, P = 0·008). In multiple linear regression analysis, EFT was found to be associated with GH levels (β-coefficient = 0·575, P = 0·008).
  
  
  CONCLUSIONS
  This study suggests that EFT and risk of subclinical cardiovascular disease are increased in patients with acromegaly. Serum GH level is an independent risk factor for EFT.
authors.affiliation: Department of Endocrinology and Metabolism, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
authors.forename: Oya
authors.initials: O
authors.lastname: Topaloglu
authors.forename: Muyesser
authors.initials: M
authors.lastname: Sayki Arslan
authors.forename: Osman
authors.initials: O
authors.lastname: Turak
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ginis
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sahin
authors.forename: Muhammet
authors.initials: M
authors.lastname: Cebeci
authors.forename: Bekir
authors.initials: B
authors.lastname: Ucan
authors.forename: Evrim
authors.initials: E
authors.lastname: Cakir
authors.forename: Basak
authors.initials: B
authors.lastname: Karbek
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozbek
authors.forename: Erman
authors.initials: E
authors.lastname: Cakal
authors.forename: Tuncay
authors.initials: T
authors.lastname: Delibasi
mesh_terms: D000172:Acromegaly / Q000097:blood* / Q000150:complications; D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D001011:Aorta / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D002339:Carotid Arteries / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D015815:Cell Adhesion Molecules / Q000097:blood*; D003430:Cross-Sectional Studies; D019040:E-Selectin / Q000097:blood; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000473:pathology*; D012307:Risk Factors; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D059289:Vascular Stiffness
chemical_list: D015815:Cell Adhesion Molecules; D019040:E-Selectin; C546936:SELE protein, human; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1