title: Arterial properties in acromegaly: relation to disease activity and associated cardiovascular risk factors.
abstract: OBJECTIVE
  Acromegaly is associated with increased cardiovascular morbidity and mortality when inadequately treated, which may be secondary to associated comorbidities or to direct IGF-1 effects on the cardiovascular system. By using a control group carefully matched for traditional cardiovascular risk factors, we aimed to assess the direct contribution of disease activity and IGF-1 levels to arterial damage as assessed by measurements of arterial stiffness and endothelial function.
  
  
  METHODS
  Twenty-nine subjects with acromegaly (11 males, 52 ± 14 year; 15 active acromegaly) and 24 matched controls underwent evaluation of large and small artery compliance using applanation tonometry, pulse wave velocity (PWV), augmentation index (Alx), carotid ultrasonography intima-media thickness, (IMT) and flow-mediated dilatation (FMD).
  
  
  RESULTS
  IGF-1 expressed as times the upper limit of the normal range (x ULN) was 2.2 ± 1.1 in patients with active disease versus 0.7 ± 0.2 in patients in remission. Irrespective of disease activity, FMD was lower in patients with acromegaly than in control subjects, (3.4 ± 2.7 % in active acromegaly, 4.4 ± 3.3 % in controlled acromegaly and 7.5 ± 3.8 % in controls; p = 0.004). There were no significant differences in PWV, Alx, and IMT between groups. A positive correlation was found between IGF-1× ULN and IMT (r = 0.4; P = 0.02). Asymmetric dimethylarginine (ADMA), a novel cardiovascular risk factor, was positively correlated to arterial stiffness (r = 0.46; p = 0.017) and negatively with small vessel compliance (r = -0.44, p = 0.02).
  
  
  CONCLUSIONS
  Patients with acromegaly have significantly impaired endothelial function as assessed by FMD, but other tested vascular parameters were similar to a control group that was adequately matched for cardiovascular risk factors.
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel. yonagr@tlvmc.gov.il.
authors.forename: Marianna
authors.initials: M
authors.lastname: Yaron
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.
authors.forename: Elena
authors.initials: E
authors.lastname: Izkhakov
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sack
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Azzam
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.
authors.forename: Etty
authors.initials: E
authors.lastname: Osher
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Karen
authors.initials: K
authors.lastname: Tordjman
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Naftali
authors.initials: N
authors.lastname: Stern
authors.affiliation: Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Weizmann 6 Street, 64239, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yona
authors.initials: Y
authors.lastname: Greenman
mesh_terms: D000172:Acromegaly / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008365:Manometry; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012307:Risk Factors; D014664:Vasodilation
chemical_list: D007334:Insulin-Like Growth Factor I
keywords: ADMA; Acromegaly; Cardiovascular risk factors; Endothelial function; Vascular function