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

Objective To evaluate risk factors for development of CHD and the occurrence of cardiac events in acromegalic patients during a 5-year 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(10FS <20) or high(FS20) risk. Coronary artery calcium content was measured using the Agatston score(AS) in all patients; those with positive AS were submitted to myocardial SPECT; cardiac events were recorded during a 5-year follow-up period.

Patients Fifty-two consecutive patients (31 women, mean age52±11yr) with controlled or uncontrolled acromegaly followed prospectively for 5 years.

Results Thirty-seven patients(71%) had low, 14 patients(27%) intermediate and 1 patient(2%) high CHD risk. CHD risk was unrelated to acromegaly activity, or the estimated duration of disease. Among patients with FS<10%, 24 had AS=0, 8 AS1 and <100, and 5 AS100 and <300, respectively. Among patients with 10FS<20%, 8 had AS=0, 4 had 1AS<100, 1 had 100AS<300 and 2 had AS300; a patient of the latter group, having AS400, increased his CHD risk from 11% to 20%. FS or AS did not differ in patients with controlled or uncontrolled acromegaly (p=0.981). All patients with positive AS had no SPECT perfusion defects. During the 5-year follow-up period no patient developed ischemic cardiac events.

Conclusions CHD risk in acromegalic patients, predicted by FS as in non-acromegalic 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.