title: Vascular Health in Patients in Remission of Cushing's Syndrome Is Comparable With That in BMI-Matched Controls.
abstract: In active Cushing's syndrome (CS), patients suffer from endothelial dysfunction and premature atherosclerosis. However, it is uncertain to what extent vascular health recovers after long-term remission. This is highly relevant because this topic relates to future development of cardiovascular disease.
  
  
  
  The objective of the study was to investigate whether micro- and macrovascular health is impaired after long-term remission of CS in patients with no or adequately treated comorbidities.
  
  
  
  This was a cross-sectional case-control study in two tertiary referral centers.
  
  
  
  Sixty-three patients (remission of CS for ≥ 4 y) and 63 healthy, well-matched controls were compared. In group A (58 patients and 58 controls), serum biomarkers associated with endothelial dysfunction, intima media thickness, pulse wave velocity, and pulse wave analysis were studied. In group B (14 patients and 14 controls), endothelium-dependent and -independent vasodilatation was studied in conduit arteries (flow mediated dilation of the brachial artery) and forearm skeletal muscle resistance arteries (vasodilator response to intraarterial acetylcholine, sodium-nitroprusside, and NG-monomethyl-L-arginine using venous occlusion plethysmography).
  
  
  
  There were no significant differences between the outcome measures of vascular health of patients and controls in groups A and B.
  
  
  
  The vascular health of patients in long-term remission of CS seems to be comparable with that of healthy gender-, age-, and body mass index-matched controls, provided that the patients have no, or adequately controlled, comorbidities. Therefore, the effects of hypercortisolism per se on the vasculature may be reversible. This accentuates the need for the stringent treatment of metabolic comorbidities in these patients.
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: M A E M
authors.initials: MA
authors.lastname: Wagenmakers
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: S H P P
authors.initials: SH
authors.lastname: Roerink
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: T H A
authors.initials: TH
authors.lastname: Schreuder
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: T S
authors.initials: TS
authors.lastname: Plantinga
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Holewijn
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: D H J
authors.initials: DH
authors.lastname: Thijssen
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: J W
authors.initials: JW
authors.lastname: Smit
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: G A
authors.initials: GA
authors.lastname: Rongen
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: A M
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: A J M
authors.initials: AJ
authors.lastname: Wagenmakers
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: R T
authors.initials: RT
authors.lastname: Netea-Maier
authors.affiliation: Department of Internal Medicine (M.A.E.M.W., S.H.P.P.R., T.S.P., S.H., J.W.S., R.T.N.-M., A.R.M.M.H.), Division of Endocrinology, Department of Integrative Physiology (T.H.A.S., D.H.J.T.), Department of Internal Medicine (G.A.R.), Division of Vascular Medicine, and Department of Pharmacology and Toxicology (G.A.R.), Radboud University Medical Center, 6500 HB, 6500 HB Nijmegen, The Netherlands; Department of Medicine (A.M.P.), Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; Research Institute for Sport and Exercise Sciences (D.H.J.T., A.J.M.W.), Liverpool John Moores University, Liverpool L3 3AF, United Kingdom.
authors.forename: A R M M
authors.initials: AR
authors.lastname: Hermus
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000150:complications*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012074:Remission Induction; D014652:Vascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D059289:Vascular Stiffness