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Risk Factors for Development of Coronary Heart Disease in Patients with Acromegaly: A Five-Year Prospective Study

Department of Endocrinology and Metabolism (F.B., S.G., C.C., C.Sa., E.M.), Cardio-Thoracic Department (V.D.B., E.T.), University of Pisa, 56124 Pisa, Italy; Second Radiodiagnostic Unit (L.B., C.Sp., F.F.), Azienda Ospedaliera Pisana, 56124 Pisa, Italy; Unit of Epidemiology and Biostatistics (G.R., P.P.), Institute of Clinical Physiology, National Research Council (C.N.R.), 56100 Pisa, Italy; and Regional Center of Nuclear Medicine (D.V., G.M.), 56100 Pisa, Italy

Address all correspondence and requests for reprints to: Fausto Bogazzi, M.D., Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy. E-mail: f.bogazzi{at}endoc.med.unipi.it or fbogazzi{at}hotmail.com.

Background: Data on coronary heart disease (CHD) are scanty and matter of argument in acromegalic patients.

Objective: The objective of this study was to evaluate risk factors for development of CHD and the occurrence of cardiac events in acromegalic patients during a 5-yr prospective study.

Design: Ten-year likelihood for CHD development was estimated by the Framingham scoring system (FS); patients were stratified as having low (FS < 10), intermediate ( 10 FS < 20), or high (FS 20) risk. Coronary artery calcium content was measured using the Agatston score (AS) in all patients; those with positive AS were submitted to myocardial single-photon emission computed tomography; cardiac events were recorded during a 5-yr follow-up period.

Patients: Fifty-two consecutive patients (31 women, mean age 52 ± 11 yr) with controlled or uncontrolled acromegaly were followed prospectively for 5 yr.

Results: Thirty-seven patients (71%) had low, 14 patients (27%) had intermediate, and one patient (2%) had high CHD risk. CHD risk was unrelated to acromegaly activity or the estimated duration of disease. Among patients with FS less than 10%, 24 had AS equal to 0, eight had AS of 1 or greater and less than 100, and five had AS 100 or greater and less than 300, respectively. Among patients with FS 10 or greater and less than 20%, nine had AS equal to 0, two had AS of one or greater and less than 100, one had AS of 100 or greater and less than 300, and two had AS of 300 or greater; a patient of the latter group, having AS of 400 or greater, increased his CHD risk from 11% to 20% or more. FS or AS did not differ in patients with controlled or uncontrolled acromegaly (P = 0.981). All patients with positive AS had no single photon emission computed tomography perfusion defects. During the 5-yr follow-up period no patient developed ischemic cardiac events.

Conclusions: CHD risk in acromegalic patients, predicted by FS as in nonacromegalic subjects, is low; AS might have adjunctive role only in a subset of patients. However, most patients have systemic complications of acromegaly, which participate in the assessment of global CHD risk.