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Nemes A, Kormányos Á, Ambrus N, Lengyel C, Valkusz Z. Myocardial, Valvular, and Vascular Structural and Functional Properties in Acromegaly. J Clin Med 2023; 12:6857. [PMID: 37959322 PMCID: PMC10648583 DOI: 10.3390/jcm12216857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Acromegaly is an uncommon systematic endocrine disease caused by the hypersecretion of human growth hormone and, consequently, of insulin-like growth factor-1 during adulthood. Acromegaly could cause a typical cardiomyopathy characterized by left ventricular hypertrophy associated with diastolic dysfunction, which later could progress to systolic dysfunction. Moreover, some valvular and vascular abnormalities are also associated with acromegaly. This present review aims to summarize available information regarding acromegaly-associated abnormalities in myocardial, valvular, and vascular structural and functional properties and their relationship to disease activity and treatment options.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary; (Á.K.); (N.A.); (C.L.); (Z.V.)
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Capillary microarchitectural changes are independent of disease activity in acromegaly. Microvasc Res 2023; 145:104444. [PMID: 36208671 DOI: 10.1016/j.mvr.2022.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/08/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although atherosclerosis-related macrovascular complications are well known in acromegaly, studies on endothelial function and arteriolar level are contradictory. In order to test the hypothesis, microvascular changes associated with macrovascular changes in acromegaly, we aimed to evaluate microvascular changes in nailfold capillaries and carotid intima-media thickness (CIMT) in patients with acromegaly. DESIGN In this cross-sectional observation study, of total 70 patients with acromegaly [ten (14.3 %) were active acromegaly (AA), 60 (85.7 %) were controlled acromegaly (CA)] and 74 healthy controls were enrolled. Microvascular structure was evaluated using the nailfold video capillaroscopy, and CIMT was measured using ultrasonography. RESULTS The median number of capillaries was less [10 no./mm (min-max: 5-16) vs. 11 no./mm (min-max: 9-15); p = 0.001] in the acromegaly group than in the controls. Capillaries below 6-8 per/mm was more common in the acromegaly patients [six (8.6 %) vs. one (1.4 %); p = 0.046]. All capillaroscopic parameters were similar among the patients with CA or AA. CIMT levels were higher in the acromegaly group than in the control group [0.60 mm (0.43-0.86) vs. 0.38 mm (0.27-0.59); p < 0.001], and AA patients had higher CIMT than CA patients (p = 0.037). None of the clinical or laboratory parameters including growth hormone and IGF-1 were related to capillaroscopic parameters or CIMT. CONCLUSION Decreased capillary number was the major capillaroscopic finding in acromegaly and there was no significant difference between active and controlled cases, but CIMT was found to be higher in the active group. Increased CIMT levels in acromegaly were not associated with capillary changes. Large-scale, prospective studies are needed to make a definite conclusion about the effect of the disease activity on nailfold capillaries and its association with macrovascular changes.
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van Montfort L, Gerver WJM, Kooger BLS, Plat J, Bierau J, Stumpel CTRM, Schott DA. Follow-Up Study of Growth Hormone Therapy in Children with Kabuki Syndrome: Two-Year Treatment Results. Horm Res Paediatr 2022; 94:285-296. [PMID: 34607328 DOI: 10.1159/000519963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kabuki syndrome (KS) is a genetic disorder with characteristic facial dysmorphisms, short stature, hypertension, and obesity later in life. The aim of this study was to evaluate catch-up growth and cardiovascular markers before and during growth hormone (rhGH) treatment in KS children. METHODS This prospective study included 18 children whose KS was genetically established. Each KS subject received rhGH for a period of 2 years. Several measurements were performed before and during treatment: anthropometry, glucose metabolism, lipid profile, markers for endothelial function, and low-grade inflammation. RESULTS This study found an increase in delta height standard deviation score (SDS) for the whole group of 1.1 SDS after 2 years of rhGH treatment. Baseline metabolic profiles showed no cardiometabolic abnormalities in these children. Although 4 out of 18 children were obese, there were no signs of the metabolic syndrome. During rhGH treatment, serum low-density lipoprotein cholesterol concentrations decreased significantly (2.16-1.91 mmol/L, p = 0.04). Apolipoprotein B100 concentrations also showed a reduction after 24 months of treatment, but the other lipid and (apo)lipoprotein parameters did not change. While other endothelial function markers were stable, only vascular cell-adhesion molecule-1 concentrations increased (1,084-1,161 pg/mL, p < 0.01) during rhGH therapy. Furthermore, BMI and waist circumference improved during treatment. There were no signs of hypertension. CONCLUSIONS At baseline and during rhGH therapy, there were no signs of the metabolic syndrome. This is the first study demonstrating that rhGH treatment in KS children is a safe and effective therapy and that it positively influences linear height without exerting adverse effects on a wide array of cardiovascular risk markers.
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Affiliation(s)
- Lieke van Montfort
- Department of Paediatrics Endocrinology, Maastricht UMC+, Maastricht, The Netherlands
| | - Willem Jan M Gerver
- Department of Paediatrics Endocrinology, Maastricht UMC+, Maastricht, The Netherlands
| | - Berbel L S Kooger
- Department of Paediatrics Endocrinology, Maastricht UMC+, Maastricht, The Netherlands
| | - Jogchum Plat
- Department of Human Biology and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jörgen Bierau
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | | | - Dina A Schott
- Department of Paediatrics, Zuyderland Medical Centre, Heerlen, The Netherlands
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Shao XQ, Chen ZY, Wang M, Yang YP, Yu YF, Liu WJ, Wang Y, Zeng FF, Gong W, Ye HY, Wang YF, Zhao Y, Zhang L, Zhang ZY, He M, Li YM. Effects of Long-Acting Somatostatin Analogues on Lipid Metabolism in Patients with Newly Diagnosed Acromegaly: A Retrospective Study of 120 Cases. Horm Metab Res 2022; 54:25-32. [PMID: 34986497 DOI: 10.1055/a-1717-9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The short-term effects of long-acting somatostatin analogues (SSAs) on lipid profiles in patients with acromegaly are not well studied. We retrospectively analyzed the effects of SSAs on lipid profiles and associated cardiovascular risk factors in a cohort of 120 newly diagnosed acromegaly patients. In this study, 69 females and 51 males were included. These patients were treated with either octreotide LAR (OCT) or lanreotide SR (LAN) for 3 months. After SSAs treatment, both GH and IGF-1 significantly decreased (p<0.001). Triglyceride (TG), total to high-density lipoprotein cholesterol (HDL-C) ratio, and lipoprotein (a) [Lp(a)] levels were significantly decreased, while HDL-C levels were increased (p<0.05). The reduction of mean serum GH (GHm) was positively associated with the decrease of TG (r=0.305, p=0.001) and Lp(a) (r=0.257, p=0.005), as well as the increase of HDL-C (r=-0.355, p<0.001). The changes of lipid profiles were observed only in OCT group, but not in LAN group. In addition, systolic blood pressure (SBP) had significantly declined after SSAs treatment, with an average reduction of 4.4 mmHg (126.7±1.28 vs. 122.3±1.44 mmHg, p=0.003), while no change was observed regarding diastolic blood pressure (DBP) (p>0.05). Fasting insulin, fasting C-peptide, and HOMA-IR were significantly decreased after SSAs treatment. In conclusion, our current study revealed that short-term SSAs treatment improves lipid profiles and other cardiovascular risk factors in patients with acromegaly.
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Affiliation(s)
- Xiao-Qing Shao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Zheng-Yuan Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye-Ping Yang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Fei Yu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Wen-Juan Liu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Fang-Fang Zeng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Gong
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-Ying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Yong-Fei Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Li Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhao-Yun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
| | - Yi-Ming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Pituitary Tumor Center, Shanghai, China
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Can M, Kocabas M, Karakose M, Yerlikaya FH, Alsancak Y, Turkmen K, Kulaksizoglu M, Karakurt F. Arterial stiffness, carotid intima-media thickness, endocan and A disintegrin-like and metalloprotease with thrombospondin type I motif 9 levels and their relationship with disease activity in acromegaly patients with and without cardiovascular risk factors. Endocr Pract 2021; 28:298-303. [PMID: 34843972 DOI: 10.1016/j.eprac.2021.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/20/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Cardiovascular complications such as cardiomyopathy and endothelial dysfunction, which are frequently seen in patients with acromegaly, are among the most important causes of morbidity and mortality. In this study, we aimed to investigate arterial stiffness, carotid intima-media thickness, endocan and A disintegrin-like and metalloprotease with thrombospondin type I motif 9 (ADAMTS9) levels and their relationship with disease activity in acromegaly patients with and without cardiovascular risk factors. DESIGN A total of 60 patients with acromegaly, 25 with active disease, 26 with well-controlled disease, and 9 newly diagnosed, and 60 age-, sex- and body mass index (BMI)-matched healthy control subjects were enrolled in this study. All subjects' height, weight, BMI, systolic blood pressure (SBP), distolic blood pressure (DBP), fasting plasma glucose (FPG), insulin, hemoglobin A1c (HbA1c), C-reactive protein (CRP), lipid, endocan, ADAMTS9, pulse wave velocity (PWV) and carotid intima-media thickness (CIMT) measurements were performed. RESULTS SBP, DBP, FPG, HbA1c and PWV levels of the acromegaly group were higher than the control group. In acromegaly patients with cardiovascular disease (CVD) risk factors, PWV was higher than the control group, and in acromegaly patients without CVD risk factor, PWV was similar to the control group. In the correlation analysis, a positive correlation was found between PWV and age, BMI, SBP, DBP, FPG and HbA1c levels in the acromegaly group. CONCLUSIONS In our study, we found that arterial stiffness increased in acromegaly patients with CVD risk factors, and that increased arterial stiffness was associated with hemodynamic (SBP, DBP) and metabolic (BMI, FPG, HBA1C) parameters.
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Affiliation(s)
- Mustafa Can
- Department of Endocrinology and Metabolism, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - Muhammet Kocabas
- Department of Endocrinology and Metabolism, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Melia Karakose
- Department of Endocrinology and Metabolism, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Yakup Alsancak
- Department of Cardiology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Kultigin Turkmen
- Department of Nephrology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mustafa Kulaksizoglu
- Department of Endocrinology and Metabolism, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Feridun Karakurt
- Department of Endocrinology and Metabolism, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Wolters TLC, van der Heijden CDCC, Pinzariu O, Hijmans-Kersten BTP, Jacobs C, Kaffa C, Hoischen A, Netea MG, Smit JWA, Thijssen DHJ, Georgescu CE, Riksen NP, Netea-Maier RT. The association between treatment and systemic inflammation in acromegaly. Growth Horm IGF Res 2021; 57-58:101391. [PMID: 33964727 DOI: 10.1016/j.ghir.2021.101391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Acromegaly is characterized by an excess of growth hormone (GH) and insulin like growth-factor 1 (IGF1), and it is strongly associated with cardiovascular diseases (CVD). Both acute and long-lasting pro-inflammatory effects have been attributed to IGF1. Previous results suggest the presence of systemic inflammation in treated patients. Here we assessed the association between treatment of acromegaly, systemic inflammation and vascular function. DESIGN Ex vivo cytokine production and circulating inflammatory markers were assessed in peripheral blood from treated and untreated acromegaly patients (N = 120), and compared them with healthy controls. A more comprehensive prospective inflammatory and vascular assessment was conducted in a subgroup of six treatment-naive patients with follow-up during treatment. RESULTS Circulating concentrations of VCAM1, E-selectin and MMP2 were higher in patients with uncontrolled disease, whereas the concentrations of IL18 were lower. In stimulated whole blood, cytokine production was skewed towards a more pro-inflammatory profile in patients, especially those with untreated disease. Prospective vascular measurements in untreated patients showed improvement of endothelial function during treatment. CONCLUSIONS Acromegaly patients are characterized by a pro-inflammatory phenotype, most pronounced in those with uncontrolled disease. Treatment only partially reverses this pro-inflammatory bias. These findings suggest that systemic inflammation could contribute to the increased risk of CVD in acromegaly patients.
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Affiliation(s)
- T L C Wolters
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - C D C C van der Heijden
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute of Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - O Pinzariu
- 6(th) Department of Medical Sciences, Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - B T P Hijmans-Kersten
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Jacobs
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Kaffa
- Centre for Molecular and Biomolecular Informatics (CMBI), Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - A Hoischen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - J W A Smit
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - D H J Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom
| | - C E Georgescu
- 6(th) Department of Medical Sciences, Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Endocrinology Clinic, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - N P Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R T Netea-Maier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Lin YC, Yu WC, Kuo CS, Chen HS. Growth hormone control and cardiovascular function in patients with acromegaly. J Chin Med Assoc 2021; 84:165-170. [PMID: 33055527 DOI: 10.1097/jcma.0000000000000445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Acromegaly is associated with cardiovascular alterations. Up to 50% acromegalic patients suffered from treatment failure after multiple modalities. We investigated correlation between cardiovascular function and control of growth hormone (GH) in acromegalic patients following transsphenoidal adenomectomy (TSA). METHODS We recruited acromegalic patients who had undergone TSA between 2006 and 2014 in this cross-sectional study. Patients were assigned to group 1, controlled acromegaly (GH <1.0 ng/mL and normalized insulin-like growth factor-1 [IGF-1]); group 2, partially controlled acromegaly (either GH >1.0 ng/mL or non-normalized IGF-1); or group 3, uncontrolled acromegaly (GH >1.0 ng/mL and non-normalized IGF-1). Echocardiography evaluated the left ventricular mass index, left ventricular ejection fraction, and the early transmitral filling velocity (E)-to-late transmitral filling velocity (A) and the E-to-the early diastolic mitral annular velocity (E') ratios. Carotid tonometry evaluated the intima-media thickness of the carotid artery, carotid-femoral pulse wave velocity, augmentation index, aortic characteristic impedance (Zc), and pulse pressure amplification. RESULTS Thirty-three patients participated in this study. Fourteen of the 33 patients were males (42%). Mean age at diagnosis was 50.33 years (SD 18.45). Compared to patients in group 1, patients in group 3 had younger age and shorter years after operation, without statistical significance. Cumulative GH levels were progressively higher from group 1 to group 3, without statistical significance. The groups did not differ with respect to cardiovascular structure and function evaluated by echocardiography and carotid tonometry. Only Zc value had a difference that was of borderline significance (group 1: 109.13 ± 32.99; group 2: 129.30 ± 32.27; group 3: 159.56 ± 77.4 dynes × s/cm5; ANOVA p = 0.088; p = 0.086 for group 1 vs group 3). CONCLUSION In the patients with acromegaly who had undergone TSA, cardiac structure and vascular stiffness did not differ among the groups with different levels of GH control.
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Affiliation(s)
- Yi-Chun Lin
- Rong Yang Clinic, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Chung Yu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Sung Kuo
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Harn-Shen Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
Acromegaly is characterized by Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) excess. Uncontrolled acromegaly is associated with a strongly increased risk of cardiovascular disease (CVD), and numerous cardiovascular risk factors remain present after remission. GH and IGF-1 have numerous effects on the immune and cardiovascular system. Since endothelial damage and systemic inflammation are strongly linked to the development of CVD, and have been suggested to be present in both controlled as uncontrolled acromegaly, they may explain the presence of both micro- and macrovascular dysfunction in these patients. In addition, these changes seem to be only partially reversible after remission, as illustrated by the often reported presence of endothelial dysfunction and microvascular damage in controlled acromegaly. Previous studies suggest that insulin resistance, oxidative stress, and endothelial dysfunction are involved in the development of CVD in acromegaly. Not surprisingly, these processes are associated with systemic inflammation and respond to GH/IGF-1 normalizing treatment.
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Affiliation(s)
- Thalijn L C Wolters
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Niels P Riksen
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Adrianus R M M Hermus
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
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Yin R, Tang X, Wang T, Shi H, Wang X, Wang X, Pan C. Cardiac CT scanning in coronary artery disease: Epicardial fat volume and its correlation with coronary artery lesions and left ventricular function. Exp Ther Med 2020; 20:2961-2968. [PMID: 32855661 PMCID: PMC7444410 DOI: 10.3892/etm.2020.9064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Coronary artery disease (CAD) is a major and common disease that poses a threat to human health. Recent studies suggested that epicardial fat may have an important role in the pathogenesis of CAD. Therefore, the association between epicardial fat volume (EFV) and left ventricular function with CAD was investigated in the present study. A total of 61 patients with suspected CAD who underwent CT scanning were enrolled. Baseline data, parameters of left heart function and EFV of the subjects were collected and analyzed. The degree of coronary artery lesions was assessed using the Gensini score. Pearson's correlation analysis and a logistic regression model were applied to assess the association between EFV and risk factors for CAD, the Gensini score and left ventricular function index. A total of 29 female and 32 male subjects with a median age of 63 years were enrolled. The median body mass index (BMI) of the subjects was 23.37 kg/m2 and the median EFV was 86.41 cm3. It was revealed that risk factors of CAD, specially hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction and smoking, had no significant association with the EFV (P>0.05); however, the EFV was significantly positively correlated with the BMI (r=0.479, P<0.0001), interventricular septal thickness (r=0.436, P=0.004), left ventricular posterior wall thickness (r=0.350, P=0.0058), left ventricular end diastolic diameter (r=0.265, P=0.0388), left ventricular mass (r=0.445, P=0.0003) and left ventricular mass index (r=0.371, P=0.0035). However, no correlation was identified between the EFV and the Gensini score (r=0.131, P=0.3137). In conclusion, the EFV measured by cardiac CT scanning was positively correlated with the BMI and left ventricular function, but was not associated with the presence of CAD according to the Gensini scores.
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Affiliation(s)
- Ruohan Yin
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Xiaoqiang Tang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Tao Wang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Xiang Wang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Xiaoqin Wang
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
| | - Changjie Pan
- Department of Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213164, P.R. China
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Wolters TLC, van der Heijden CDCC, van Leeuwen N, Hijmans-Kersten BTP, Netea MG, Smit JWA, Thijssen DHJ, Hermus ARMM, Riksen NP, Netea-Maier RT. Persistent inflammation and endothelial dysfunction in patients with treated acromegaly. Endocr Connect 2019; 8:1553-1567. [PMID: 31751301 PMCID: PMC6933829 DOI: 10.1530/ec-19-0430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Acromegaly is characterized by an excess of growth hormone (GH) and insulin-like growth factor 1 (IGF1). Cardiovascular disease (CVD) risk factors are common in acromegaly and often persist after treatment. Both acute and long-lasting pro-inflammatory effects have been attributed to IGF1. Therefore, we hypothesized that inflammation persists in treated acromegaly and may contribute to CVD risk. METHODS In this cross-sectional study, we assessed cardiovascular structure and function, and inflammatory parameters in treated acromegaly patients. Immune cell populations and inflammatory markers were assessed in peripheral blood from 71 treated acromegaly patients (with controlled or uncontrolled disease) and 41 matched controls. Whole blood (WB) was stimulated with Toll-like receptor ligands. In a subgroup of 21 controls and 33 patients with controlled disease, vascular ultrasound measurements were performed. RESULTS Leukocyte counts were lower in patients with controlled acromegaly compared to patients with uncontrolled acromegaly and controls. Circulating IL18 concentrations were lower in patients; concentrations of other inflammatory mediators were comparable with controls. In stimulated WB, cytokine production was skewed toward inflammation in patients, most pronounced in those with uncontrolled disease. Vascular measurements in controlled patients showed endothelial dysfunction as indicated by a lower flow-mediated dilatation/nitroglycerine-mediated dilatation ratio. Surprisingly, pulse wave analysis and pulse wave velocity, both markers of endothelial dysfunction, were lower in patients, whereas intima-media thickness did not differ. CONCLUSIONS Despite treatment, acromegaly patients display persistent inflammatory changes and endothelial dysfunction, which may contribute to CVD risk and development of CVD.
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Affiliation(s)
- T L C Wolters
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C D C C van der Heijden
- Division of Experimental Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Vascular Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N van Leeuwen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B T P Hijmans-Kersten
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G Netea
- Division of Experimental Internal Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J W A Smit
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - A R M M Hermus
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N P Riksen
- Division of Vascular Medicine, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Correspondence should be addressed to R T Netea-Maier:
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11
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Calan M, Demirpence M. Increased circulating levels of irisin are associated with cardiovascular risk factors in subjects with acromegaly. Hormones (Athens) 2019; 18:435-442. [PMID: 31696447 DOI: 10.1007/s42000-019-00151-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
AIMS Irisin, a peptide secreted from muscle and adipose tissues, is associated with insulin resistance as well as metabolic and cardiovascular diseases. Acromegaly is a rare disorder caused by overproduction of growth hormone (GH) and is associated with functional and structural differentiation of adipose and muscle tissues. Acromegalic subjects are also at risk of vascular diseases and metabolic dysfunctions. We aimed to determine the altered levels of irisin in subjects with active acromegaly and controlled acromegaly and in controls, and to ascertain whether there is an association between irisin and hormonal and cardiometabolic parameters. METHODS We enrolled 40 subjects with active acromegaly, 30 subjects with controlled acromegaly, and 40 control subjects of matched age, gender, BMI, and occurrence of hypertension, diabetes, and metabolic syndrome distribution in the present cross-sectional study. Hormonal and metabolic parameters, carotid intima media thickness (cIMT), and epicardial fat thickness (EFT) of the subjects were evaluated. Irisin levels were measured using ELISA. RESULTS Circulating levels of irisin were significantly higher in acromegalic subjects compared to both controlled acromegalic subjects and controls. Moreover, irisin levels were elevated in controlled acromegalic subjects compared to controls. Irisin displayed a positive correlation with insulin resistance, cIMT, EFT, BMI, GH, and insulin-like growth factor (IGF-1) in acromegalic subjects. Irisin levels were independently associated with cIMT and EFT according to multiple regression analyses. There was an independent relationship between irisin and IGF-1. CONCLUSIONS Elevated irisin levels in acromegalic subjects were associated with cIMT and EFT, suggesting that irisin is a surrogate marker for cardiovascular risk in acromegalic subjects.
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Affiliation(s)
- Mehmet Calan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey.
| | - Mustafa Demirpence
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
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12
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Gatto F, Campana C, Cocchiara F, Corica G, Albertelli M, Boschetti M, Zona G, Criminelli D, Giusti M, Ferone D. Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly. Rev Endocr Metab Disord 2019; 20:365-381. [PMID: 31342434 DOI: 10.1007/s11154-019-09506-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acromegaly is a rare chronic, systemic disorder caused by excessive growth hormone (GH) secretion from a somatotroph pituitary adenoma. GH hypersecretion leads to overproduction of insulin-like growth factor-1 (IGF-1), which contributes to the somatic overgrowth, physical disfigurement, onset of multiple systemic comorbidities, reduced quality of life (QoL) and premature mortality of uncontrolled patients. Somatostatin receptor ligands, dopamine agonists and a GH receptor antagonist are currently available for medical therapy of acromegaly. The main aim of treatment is biochemical normalisation, defined as age-normalised serum IGF-1 values and random GH levels <1.0 μg/L. However, there is an increasing evidence suggesting that achieving biochemical control does not always decrease the burden of disease-related comorbidities and/or improve patients' QoL. This lack of correlation between biochemical and clinical control can be due to both disease duration (late diagnosis) or to the peculiarity of a given comorbidity. Herein we conducted ad hoc literature searches in order to find the most recent and relevant reports on biochemical and clinical disease control during medical treatment of acromegaly. Particularly, we analyse and describe the relationship between biochemical, as well as clinical disease control in patients with acromegaly receiving medical therapy, with a focus on comorbidities and QoL. In conclusion, we found that current literature data seem to indicate that clinical disease control (besides biochemical control), encompassing clinical signs and symptoms, comorbidities and QoL, emerge as a primary focus of acromegaly patient management.
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Affiliation(s)
- Federico Gatto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy.
| | - Claudia Campana
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Francesco Cocchiara
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Giuliana Corica
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Mara Boschetti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Gianluigi Zona
- Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Diego Criminelli
- Neurosurgery Unit, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Massimo Giusti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16142, Genoa, Italy.
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 16142, Genoa, Italy.
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13
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Briet C, Ilie MD, Kuhn E, Maione L, Brailly-Tabard S, Salenave S, Cariou B, Chanson P. Changes in metabolic parameters and cardiovascular risk factors after therapeutic control of acromegaly vary with the treatment modality. Data from the Bicêtre cohort, and review of the literature. Endocrine 2019; 63:348-360. [PMID: 30397873 DOI: 10.1007/s12020-018-1797-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022]
Abstract
CONTEXT Untreated acromegaly is associated with increased morbidity and mortality due to malignant, cardiovascular, and cerebrovascular disorders. Effective treatment of acromegaly reduces excess mortality, but its impact on cardiovascular risk factors and metabolic parameters are poorly documented. AIM We analyzed changes in cardiovascular risk factors and metabolic parameters in patients receiving various treatment modalities. PATIENTS AND METHODS We retrospectively studied 96 patients with acromegaly, both at diagnosis and after IGF-I normalization following surgery alone (n = 51) or medical therapy with first generation somatostatin analogues (SSA, n = 23), or pegvisomant (n = 22). Duration of follow-up was 77 (42-161) months, 75 (42-112) months, and 62 (31-93) months, in patients treated with surgery alone, SSA, and pegvisomant, respectively. In all the cases except four, patients treated medically had underwent previous unsuccessful surgery. RESULTS IGF-I normalization was associated with increased body weight, decreased systolic blood pressure (SBP) in hypertensive patients, decreased fasting plasma glucose (FPG) and HOMA-IR and HOMA-B levels, increased HDL cholesterol (HDLc); whereas, LDL cholesterol (LDLc) was not significantly different. Plasma PCSK9 levels were unchanged in patients with available values. Cardiovascular and metabolic changes varied with the treatment modality: surgery, but not pegvisomant, had a beneficial effect on SBP; FPG decreased after surgery but increased after SSA; the decline in HOMA-IR was only significant after surgery; pegvisomant significantly increased LDLc and total cholesterol; whereas SA increased HDLc and had no effect on LDLc levels. CONCLUSION Treatments used to normalize IGF-I levels in patients with acromegaly could have differential effects on cardiovascular risk factors and metabolic parameters.
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Affiliation(s)
- Claire Briet
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France
- Institut MITOVASC, INSERM U1083, Université d'Angers, Département d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalier Universitaire d'Angers, F-49933, Angers, France
| | - Mirela Diana Ilie
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France
| | - Emmanuelle Kuhn
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France
- Univ Paris-Sud, Faculté de Médecine Paris-Sud, F-94276, Le Kremlin Bicêtre, France
- Unité Mixte de Recherche-S1185, F-94276, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185, F-94276, Le Kremlin Bicêtre, France
| | - Luigi Maione
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France
- Univ Paris-Sud, Faculté de Médecine Paris-Sud, F-94276, Le Kremlin Bicêtre, France
- Unité Mixte de Recherche-S1185, F-94276, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185, F-94276, Le Kremlin Bicêtre, France
| | - Sylvie Brailly-Tabard
- Univ Paris-Sud, Faculté de Médecine Paris-Sud, F-94276, Le Kremlin Bicêtre, France
- Unité Mixte de Recherche-S1185, F-94276, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185, F-94276, Le Kremlin Bicêtre, France
| | - Sylvie Salenave
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France
| | - Bertrand Cariou
- l'Institut du Thorax, INSERM, CNRS, Univ Nantes, CHU Nantes, F-44000, Nantes, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France.
- Univ Paris-Sud, Faculté de Médecine Paris-Sud, F-94276, Le Kremlin Bicêtre, France.
- Unité Mixte de Recherche-S1185, F-94276, Le Kremlin Bicêtre, France.
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185, F-94276, Le Kremlin Bicêtre, France.
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14
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Demirpence M, Guler A, Yilmaz H, Sayin A, Pekcevik Y, Turkon H, Colak A, Ari EM, Aslanipour B, Kocabas GU, Calan M. Is elevated urotensin II level a predictor for increased cardiovascular risk in subjects with acromegaly? J Endocrinol Invest 2019; 42:207-215. [PMID: 29804270 DOI: 10.1007/s40618-018-0905-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Acromegaly is a rare disorder existed in the result of overproduction of growth hormone (GH). The disorder is associated with increased cardiovascular risk factors and metabolic abnormalities. Urotensin II (UII), a secreted vasoactive peptide hormone, belonging somatostatin superfamily, plays an essential role in atherosclerosis and glucose metabolism. The aim of this study was to ascertain whether circulating UII levels are altered in subjects with acromegaly, and to describe the relationship between UII and hormonal or cardiometabolic parameters. METHODS This cross-sectional study included 41 subjects with active acromegaly, 28 subjects with controlled acromegaly, and 37 age- and BMI-matched controls without acromegaly. Hormonal and metabolic features of the subjects as well as carotid intima media thickness (cIMT) and epicardial fat thickness (EFT) were defined. Circulation of UII levels was determined via ELISA. RESULTS Both active and controlled acromegalic subjects showed a significant elevation of circulating levels of UII with respect to controls. There was no remarkable difference in circulating levels of UII between active and controlled acromegalic groups. Both cIMT and EFT were remarkably increased in acromegaly subjects comparing to controls. UII positively correlated with cIMT, EFT, BMI, and HOMA-IR. There was no correlation between UII and GH, insulin-like growth factor-1. According to the results obtained from regression models, UII levels independently predicted cIMT and EFT. CONCLUSION Elevated UII levels are associated with severity of cardiovascular risk factors including cIMT and EFT in acromegalic subjects.
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Affiliation(s)
- M Demirpence
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - A Guler
- Department of Family Physician, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey
| | - H Yilmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - A Sayin
- Department of Cardiology, Izmir Tepecik Research and Training Hospital, Tepecik, 35120, Izmir, Turkey
| | - Y Pekcevik
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - H Turkon
- Department of Medical Biochemistry, Faculty of Medicine, Canakkale Onsekiz Mart University, 17120, Canakkale, Turkey
| | - A Colak
- Department of Clinical Biochemistry, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - E M Ari
- Department of Clinical Biochemistry, Izmir Tepecik Training and Research Hospital, Tepecik, 35120, Izmir, Turkey
| | - B Aslanipour
- Department of Bioengineering, Faculty of Engineering, Ege University, Bornova, 35100, Izmir, Turkey
| | - G U Kocabas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey
| | - M Calan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Izmir Bozyaka Training and Research Hospital, Bozyaka, 35170, Izmir, Turkey.
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15
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Maffei P, Dassie F, Wennberg A, Parolin M, Vettor R. The Endothelium in Acromegaly. Front Endocrinol (Lausanne) 2019; 10:437. [PMID: 31396153 PMCID: PMC6667653 DOI: 10.3389/fendo.2019.00437] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Growth hormone (GH) and insulin like growth factor-1 (IGF-1) excess induce well-known deleterious effects on the cardiovascular system, especially after long-term exposition. Acromegaly, a condition of chronic GH and IGF-1 hypersecretion, is frequently associated to cardiovascular complications, although recent studies have shown a reduction in the prevalence of these comorbidities in well-controlled patients and a mortality risk similar to normal aging population. Many factors could contribute to the increased cardiovascular risk of acromegaly patients. Among these factors, the endothelium plays a key role in the pathogenesis of atherosclerotic plaques and could be considered an early marker of atherosclerosis and cardiovascular dysfunction. In this review we examined the relationship between GH/IGF-1 excess and the endothelium, from basic studies to clinical evidence. Many studies involving various arterial districts (microvascular arteries of retina, kidney and brain, and major vessels as carotid and aorta) showed that GH/IGF-1 excess promotes endothelial dysfunction via several different mechanisms. Increased endothelial proliferation, dysfunction of endothelial progenitor cells, increased oxidative stress, and compromised oxidative defenses are the main factors that are associated with endothelial dysfunction. In the general population, these alterations are associated with the development of atherosclerosis with an increased incidence of coronary artery disease and cerebrovascular complications. However, in acromegaly this is still a debated issue, despite the presence of many pro-atherogenic factors and comorbidities, such as hypertension, diabetes, sleep apnoea, and metabolic syndrome. Preclinical markers of atherosclerosis as arterial intima media thickness, pulse wave velocity and flow mediated dilation seem to be impaired in acromegaly and partly mediated by the endothelium dysfunction. In conclusion, the pathophysiology of endothelial dysfunction in the condition of GH and IGF-1 excess remains a crucial area of investigation to fully dissect the association of acromegaly with cardiovascular disease complications.
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Affiliation(s)
- Pietro Maffei
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
- *Correspondence: Pietro Maffei
| | - Francesca Dassie
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Alexandra Wennberg
- Clinica Neurologica, Department of Neurosciences (DNS), Padua University Hospital, Padua, Italy
| | - Matteo Parolin
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
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Ramos-Leví AM, Marazuela M. Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them? Front Endocrinol (Lausanne) 2019; 10:120. [PMID: 30930848 PMCID: PMC6423916 DOI: 10.3389/fendo.2019.00120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.
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17
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Parolin M, Dassie F, Martini C, Mioni R, Russo L, Fallo F, Rossato M, Vettor R, Maffei P, Pagano C. Preclinical markers of atherosclerosis in acromegaly: a systematic review and meta-analysis. Pituitary 2018; 21:653-662. [PMID: 30225826 DOI: 10.1007/s11102-018-0911-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Multiple studies investigated preclinical markers of peripheral vascular damage in acromegaly (ACRO) reporting discordant results. The aim of this study was to run a meta-analysis to examine whether intima media thickness (IMT), flow mediated dilation (FMD) and arterial pulse wave velocity (PWV) are affected in acromegalic patients and to assess the impact of effective treatment of growth hormone excess on these outcomes. STUDY SELECTION Twenty-seven studies comparing ACRO vs control (CON) populations and active (ACT) vs inactive (INACT) ACRO were included in the meta-analysis. DATA SYNTHESIS ACRO compared to CON have higher IMT (ES = 0.83, 95% C.I. 0.35-1.30), p = 0.001, impaired FMD (ES = - 1.59, 95% C.I. - 2.33 to - 0.85, p < 0.0001) and higher PWV (ES = 0.76 95% C.I. 0.37-1.16, p = 0.0001). When patients with ACT vs INACT disease were considered IMT was higher (ES = 0.43, 95% C.I. 0.02-0.84, p = 0.041) and FMD was impaired (ES = - 0.66, 95% C.I. - 1.28 to 0.04, p = 0.038) in ACT patients. Meta-regression analysis of studies comparing IMT in ACT vs INACT acromegalic patients showed a significant and inverse association between the effect size and the percent of hypertensive (p = 0.025) and diabetic (p = 0.041) patients. CONCLUSIONS IMT, FMD and arterial stiffness are impaired in acromegaly showing that these patients may be at increased risk of atherosclerosis. In patients with active disease these preclinical markers of atherosclerosis are worse compared to patients with inactive disease but the role of diabetes and hypertension is prevailing on growth hormone excess.
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Affiliation(s)
- Matteo Parolin
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesca Dassie
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Chiara Martini
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Mioni
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Lucia Russo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Marco Rossato
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Vettor
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
| | - Pietro Maffei
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
| | - Claudio Pagano
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Via Giustiniani 2, 35128, Padova, Italy
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Mizera Ł, Elbaum M, Daroszewski J, Bolanowski M. CARDIOVASCULAR COMPLICATIONS OF ACROMEGALY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:365-374. [PMID: 31149285 PMCID: PMC6525769 DOI: 10.4183/aeb.2018.365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acromegaly is associated with increased mortality and decreased life expectancy. Cardiovascular disease is the principal cause of premature mortality in patients with acromegaly, accounting for about 60% of deaths. GH and/or IGF-I exert direct cardiac effects: enhance cardiac contractility, stimulate cardiomyocyte growth, influence calcium influx in cardiomyocytes. Cardiac remodelling is influenced by hypertension and insulin resistance. Among cardiovascular risk factors arterial hypertension, reported in 35% of patients with acromegaly, ranks among most important negative prognostic factors for mortality. Hypertension plays significant role in the development of cardiac hypertrophy, especially in older acromegalic patients and diastolic blood pressure is best predictive factor for cardiac hypertrophy. Therefore, early and aggressive hypertension treatment is essential for prognosis in acromegaly. Other important risk factors are: valvular defects, arrhythmias, endothelial dysfunction, heart failure, lipid abnormalities and coronary artery disease. Numerous studies suggest that patients with acromegaly are under threat of arrhythmias, especially those with structural heart abnormalities. Congestive heart failure as end-stage acromegalic cardiomyopathy occurs usually in older patients, with long-term uncontrolled disease and other cardiovascular and metabolic complications. Relation between acromegaly and coronary artery disease is controversial as it seems to be connected rather with classical cardiovascular risk factors than GH and IGF-1 overexpresion.
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Affiliation(s)
| | | | | | - M. Bolanowski
- Medical University, Diabetes and Isotope Therapy, Dept. of Endocrinology, Wroclaw, Poland
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Pivonello R, Auriemma RS, Grasso LFS, Pivonello C, Simeoli C, Patalano R, Galdiero M, Colao A. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary 2017; 20:46-62. [PMID: 28224405 DOI: 10.1007/s11102-017-0797-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Acromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemical control of acromegaly significantly improves cardiovascular disease, albeit completely recovering to normal mainly in young patients with short disease duration. Respiratory complications, represented mainly by sleep-breathing disorders, particularly sleep apnea, and respiratory insufficiency, frequently occur at the early stage of the disease and, although their severity decreases with disease control, this improvement does not often change the indication for a specific therapy directed to improve respiratory function. Metabolic complications, including glucose and lipid disorders, are variably reported in acromegaly. Treatments of acromegaly may influence glucose metabolism, and the presence of diabetes mellitus in acromegaly may affect the choice of treatments, so that glucose homeostasis is worth being monitored during the entire course of the disease. Early diagnosis and prompt treatment of acromegaly, aimed at obtaining a strict control of hormone excess, are the best strategy to limit the development or reverse the complications and prevent the premature mortality.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy.
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Ludovica F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Mariano Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, via S. Pansini 5, 80131, Naples, Italy
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Aulinas A, Crespo I, Viladés D, Leta R, Urgell E, Biagetti B, Webb SM, Valassi E. Cystatin-C and epicardial adipose tissue as noninvasive predictors of cardiovascular risk in acromegaly. Clin Endocrinol (Oxf) 2017; 86:214-222. [PMID: 27910111 DOI: 10.1111/cen.13273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/13/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acromegaly (ACRO) is associated with elevated cardiovascular risk, although the prevalence of coronary artery disease (CAD) is unclear. Increased epicardial adipose tissue (EAT) and elevated cystatin-C (Cys-C) levels are cardiovascular risk factors, also related to the progression of CAD in several populations. AIMS To measure the severity and extent of CAD in patients with ACRO and to determine whether either EAT or Cys-C reflect higher cardiovascular risk in patients with ACRO than in healthy controls. SUBJECTS AND METHODS Case-control study, of 35 patients with ACRO (19 males, 17 with active disease) and 35 age-, gender- and body mass index (BMI)-matched healthy controls; mean age was 48·1 ± 8·1 years and mean BMI was 27·6 ± 4·8 kg/m2 . Cys-C was measured by an immunoturbidimetric assay. The 10-year risk of developing a coronary event was calculated using the Framingham Risk Score (FRS). EAT index (volume indexed to body surface area), and severity and extent of CAD were measured using a 256-slice multidetector computed tomography scanner (iCT-256 Philips Healthcare, Amsterdam). RESULTS Coronary artery disease lesions, EAT index and severity/extent of CAD were similar between patients with ACRO and controls. Forty-four per cent of patients with ACRO had mild coronary lesions associated with greater EAT index (ß = 0·022, P = 0·036). Cys-C levels correlated with both EAT index (ρ = 0·386, P = 0·031) and FRS (ρ = 0·477, P = 0·004) in patients with ACRO only, despite similar prevalence of traditional cardiovascular risk factors. In a multiple linear regression model, both Cys-C levels (ß = 0·369, P = 0·007) and EAT index (ß = 0·29, P = 0·025) predicted FRS (R2 = 0·613). CONCLUSIONS In patients with ACRO, both Cys-C and EAT index might be used as noninvasive predictors of cardiovascular risk.
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Affiliation(s)
- Anna Aulinas
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Hospital Universitari de Vic, Barcelona, Spain
| | - Iris Crespo
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - David Viladés
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Ruben Leta
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Eulàlia Urgell
- Biochemistry Department, Hospital Sant Pau, Barcelona, Spain
| | - Betina Biagetti
- Endocrinology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Department, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Valassi E, Crespo I, Malouf J, Vilades D, Leta R, Llauger J, Urgell E, Aulinas A, Marín AM, Biagetti B, Webb SM. Epicardial fat is a negative predictor of spine volumetric bone mineral density and trabecular bone score in acromegaly. Endocrine 2016; 53:860-4. [PMID: 27055553 DOI: 10.1007/s12020-016-0945-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/26/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Elena Valassi
- Endocrinology/Medicine Department, Research Center for Pituitary Diseases, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.
| | - Iris Crespo
- Endocrinology/Medicine Department, Research Center for Pituitary Diseases, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Jorge Malouf
- Mineral Metabolism Unit, Medicine Department, Hospital Sant Pau, Barcelona, Spain
| | - David Vilades
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Ruben Leta
- Cardiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Jaume Llauger
- Radiology Department, Hospital Sant Pau, Barcelona, Spain
| | - Eulàlia Urgell
- Biochemistry Department, Hospital Sant Pau, Barcelona, Spain
| | - Anna Aulinas
- Endocrinology/Medicine Department, Research Center for Pituitary Diseases, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
| | - Ana Maria Marín
- Mineral Metabolism Unit, Medicine Department, Hospital Sant Pau, Barcelona, Spain
| | - Betina Biagetti
- Endocrinology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Department, Research Center for Pituitary Diseases, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Mª Claret 167, 08025, Barcelona, Spain
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Peraza-Zaldívar JA, Suárez-Cuenca JA, Aceves-Millán R, Ixcamparij-Rosales C, Amezcua L, Pérez-Cabeza de Vaca R, Guerrero-Celis N, Melchor-López A, Mondragón-Terán P, Alcaráz-Estrada SL. Pro-atherogenic mediators and subclinical atherogenesis are related to epicardial adipose tissue thickness in patients with cardiovascular risk. J Int Med Res 2016; 45:1879-1891. [PMID: 27503947 PMCID: PMC5805178 DOI: 10.1177/0300060516655245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the relationship between pro-atherogenic biomarkers and
epicardial adipose tissue (EAT) thickness in patients with cardiovascular
risk factors. Methods Plasma nitric oxide (NO), soluble intercellular adhesion molecule-1 and
malondialdehyde (MDA) levels, EAT thickness, flow-mediated dilation (FMD)
and carotid intima media thickness (CIMT) were determined in patients aged
>18 years who were referred for echocardiography for heart ischemia or
non-ischemic diseases. Cardiovascular risk factors (Framingham score
[FS] ≥ 20) were weighted. Results Hypertension, dyslipidaemia and type 2 diabetes mellitus were prevalent (≥55%
of 40 patients). Patients with FS ≥ 20 (n = 21) showed
significantly higher EAT and CIMT values. Globally, MDA, CIMT, age, waist
circumference, high-density lipoprotein cholesterol (HDL-C) and FS were
associated with EAT thickness. EAT was significantly associated with NO in
patients with FS ≥ 20. Significant differences in EAT thickness were found
between patients stratified by NO value, FMD, age, smoking status,
dyslipidaemia, type 2 diabetes mellitus and FS. An EAT-associated
atherogenic risk (CIMT ≥ 1 mm) model was statistically significant when MDA
and type 2 diabetes mellitus were included. Conclusion EAT thickness was associated with MDA, CIMT, age, waist circumference, HDL-C
and FS globally, but with NO only in patients with FS≥20. EAT may be used to
identify vascular damage stage, possibly influenced by MDA and type 2
diabetes mellitus.
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Affiliation(s)
- Juan A Peraza-Zaldívar
- 1 Division of Echocardiography, National Medical Center '20 de Noviembre' ISSSTE, Mexico City, Mexico
| | - Juan A Suárez-Cuenca
- 2 Division of Clinical and Biomedical Research, National Medical Center '20 de Noviembre' ISSSTE and Instituto Mexicano del Seguro Social, Mexico City, Mexico.,3 Department of Internal Medicine, Hospital General Xoco, Mexico City, Mexico
| | - Rocío Aceves-Millán
- 1 Division of Echocardiography, National Medical Center '20 de Noviembre' ISSSTE, Mexico City, Mexico
| | - Carlos Ixcamparij-Rosales
- 1 Division of Echocardiography, National Medical Center '20 de Noviembre' ISSSTE, Mexico City, Mexico
| | - Lilia Amezcua
- 1 Division of Echocardiography, National Medical Center '20 de Noviembre' ISSSTE, Mexico City, Mexico
| | - Rebeca Pérez-Cabeza de Vaca
- 2 Division of Clinical and Biomedical Research, National Medical Center '20 de Noviembre' ISSSTE and Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Nuria Guerrero-Celis
- 2 Division of Clinical and Biomedical Research, National Medical Center '20 de Noviembre' ISSSTE and Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Paul Mondragón-Terán
- 2 Division of Clinical and Biomedical Research, National Medical Center '20 de Noviembre' ISSSTE and Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sofía L Alcaráz-Estrada
- 2 Division of Clinical and Biomedical Research, National Medical Center '20 de Noviembre' ISSSTE and Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Ozkan C, Altinova AE, Cerit ET, Yayla C, Sahinarslan A, Sahin D, Dincel AS, Toruner FB, Akturk M, Arslan M. Markers of early atherosclerosis, oxidative stress and inflammation in patients with acromegaly. Pituitary 2015; 18:621-9. [PMID: 25500981 DOI: 10.1007/s11102-014-0621-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Data regarding atherosclerosis in acromegaly is controversial in literature. We aimed to investigate the markers of early atherosclerosis, oxidative stress, inflammation and their relationships with each other in acromegaly. METHODS Thirty-nine patients with acromegaly and 40 control subjects were enrolled. Patients were classified into two groups; active acromegaly (AA) and controlled acromegaly (CA). Controls were matched by age, gender, body mass index and presence of cardiovascular risk factors. Flow mediated dilatation (FMD), carotid intima media thickness (CIMT), epicardial adipose tissue thickness (EAT) were measured and serum levels of oxidative stress parameters, high mobility group box 1 protein (HMGB1) and high sensitive CRP (hs CRP) were evaluated. RESULTS Significantly decreased FMD, increased CIMT and EAT were found in patients with acromegaly compared to controls (p < 0.01, p < 0.05, p < 0.001, respectively). EAT correlated negatively with FMD (r = -0.24, p = 0.038) and positively with CIMT (r = 0.37, p < 0.01). Presence of acromegaly, hypertension and age were found to be the predictors of early atherosclerosis (p < 0.05). Hs CRP was decreased in AA compared to controls (p = 0.01). There were no significant differences for HMGB1 and oxidized LDL (ox-LDL) cholesterol levels and total antioxidant capacity (TAC) between AA, CA and controls (p > 0.05). CONCLUSION Early atherosclerosis measured with FMD, CIMT and EAT may exist in acromegaly. However, decreased hs CRP and unchanged HMGB1, ox-LDL and TAC levels suggest that inflammation and oxidative stress do not seem to contribute to the development of atherosclerosis in these patients.
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Affiliation(s)
- Cigdem Ozkan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey,
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Üçler R, Aslan M, Atmaca M, Alay M, Ademoğlu EN, Gülşen I. Evaluation of blood neutrophil to lymphocyte and platelet to lymphocyte ratios according to plasma glucose status and serum insulin-like growth factor 1 levels in patients with acromegaly. Hum Exp Toxicol 2015. [PMID: 26224042 DOI: 10.1177/0960327115597313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cardiovascular, respiratory, and cerebrovascular diseases and malignancies are responsible for morbidity and mortality in acromegaly. Also these diseases are associated with chronic inflammation. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are currently gaining interest as new markers of inflammation. Moreover, increased morbidity and mortality are positively correlated with the presence of diabetes and levels of insulin-like growth factor 1 (IGF-1) in acromegaly. The objective of the present study was to investigate the relationship between these markers and acromegaly according to plasma glucose status and serum IGF-1 levels. MATERIALS AND METHODS We retrospectively analyzed data from 61 acromegaly patients who were in a newly diagnosed period (35 male, 26 female; mean age 38.13 ± 13.98). Patients with normal plasma glucose (n = 27), impaired fasting glucose (n = 18), and diabetes mellitus (n = 16) were categorized into three different groups. NLR and PLR were compared between the study groups and were evaluated according to IGF-1 levels. RESULTS There were no statistically significant differences in NLR and PLR measurements among the study groups (p > 0.05). However, there were significant positive correlations between NLR and IGF-1 levels and between PLR and IGF-1 levels when all patients were evaluated (r = 0.334, p = 0.011 and r = 0.277, p = 0.035, respectively). CONCLUSIONS This is the first report studying the relationship of NLR and PLR with glucose status and IGF-1 levels in acromegaly patients. Our study results suggest that subclinical inflammation may play a role in increased incidence of mortality and morbidity, which depends on uncontrolled IGF-1 levels in patients with acromegaly.
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Affiliation(s)
- R Üçler
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - M Aslan
- Department of Internal Medicine, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - M Atmaca
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - M Alay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - E N Ademoğlu
- Department of Endocrinology and Metabolism, Bitlis State Hospital, Bitlis, Turkey
| | - I Gülşen
- Department of Neurosurgery, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
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