title: Cardiovascular risk factors in patients with Addison's disease: a comparative study of South African and Swedish patients.
abstract: BACKGROUND
  Patients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa.
  
  
  METHODS
  In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied.
  
  
  RESULTS
  All patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1-2.46) versus 0.96 (0.74-1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93-5.45) versus 0.99 (0.57-2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus.
  
  
  CONCLUSIONS
  South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Ian Louis
authors.initials: IL
authors.lastname: Ross
authors.affiliation: Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ragnhildur
authors.initials: R
authors.lastname: Bergthorsdottir
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
authors.affiliation: Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Joel Alex
authors.initials: JA
authors.lastname: Dave
authors.affiliation: Department of Paediatrics, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Desmond
authors.initials: D
authors.lastname: Schatz
authors.affiliation: Division of Chemical Pathology, Clinical Laboratory Sciences, National Health Laboratory Service, University of Cape Town, Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Marais
authors.affiliation: Department of Endocrinology, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D052242:Adiponectin / Q000097:blood; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D018836:Inflammation Mediators / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013019:South Africa; D013548:Sweden
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D008055:Lipids; D002097:C-Reactive Protein; D006854:Hydrocortisone