Context: Coronary atherosclerosis in acromegaly was not extensively investigated in the literature, until now. At autopsy, it was demonstrated in about 20% of patients with long-lasting disease and myocardial infarction was reported as cause of death in a quarter of acromegalics.

Objective: To evaluate coronary atherosclerosis in a cohort of acromegalics with controlled or uncontrolled disease.

Design: Coronary risk was evaluated by the Framingham algorithm, according to the Framingham score (FS). Patients were stratified into low (<6%), intermediate (6-20%) and high (>20%) mid-term risk. Coronary calcium deposits were detected by multi-detector computed tomography (MDCT) and measured by the Agatston algorithm. Coronary artery calcium (AS) was quantified at the level of left main artery (LMA), left anterior descendent artery (LADA), left circumflex artery (LCA), right coronary artery (RCA) and posterior descendent artery (PDA). Total AS values in healthy persons are <50 (age <60 yr) and <300 (age 60 yr).

Patients: 39 patients (12 M and 27 F, age 53.0 ± 2.1 yr) were evaluated. In each patient, the mean of at least 4 determinations of serum IGF-1, assayed during the last 2 yr before study, was normalized for the age-matched normal range and the result was presented as SD value (IGF-1 SD). On the basis of serum IGF-1 SD, acromegaly was considered controlled (1.9 SD; n = 24) or uncontrolled (2.0 SD; n = 15).

Results: The FS was intermediate in 12 and high in 2 acromegalics. Overall, the FS was not correlated with serum GH values and IGF-1 SD. Mean FS was not significantly different between patients with controlled and with uncontrolled acromegaly. Total AS was increased in 9 patients, most frequently in LAD, in LCA and in LMA. In these 9 patients, mean AS was similar in individuals with controlled and in those with uncontrolled acromegaly and the rate of 17% patients with controlled disease having increased AS was not statistically different from the rate of 33% uncontrolled acromegalics. Total AS was increased in 6/12 males and in 3/27 females (² 7.1, P < 0.01). Overall, total AS correlated with FS (r² = 0.4, P < 0.0002), but not with age, BMI, disease duration, LVMi, serum cholesterol, triglycerides, GH or IGF-1 levels. Increased AS was more frequently observed in acromegalics with diabetes mellitus (² = 5.2, P < 0.05) or hypertension (² = 9.8, P < 0.002), but not in smokers (² = 1.34, p NS). Seven out of 9 patients with coronary calcium deposits had a FS >6%. In 6/13 patients with FS >6%, MDCT did not demonstrate coronary calcifications.

Conclusions: In our study, the integrated evaluation of FS and of AS showed that 41% of acromegalics are at risk for coronary atherosclerosis and that coronary calcifications were evident in about half of them, despite myocardial infarction was not more frequent in acromegalic patients than in the general population. Moreover, the control of acromegaly did not influence significantly the extent of coronary atherosclerosis.