Increased arterial intima-media thickness by B-M mode echodoppler ultrasonography in acromegaly

BACKGROUND Patients with acromegaly have an increased morbidity and mortali ty for cardiovascular diseases. Despite the increasing evidence for the exi stence of a specific cardiomyopathy it; acromegaly, the presence of vascula r abnormalities has been never investigated. OBJECTIVE To evaluate the cardiovascular risk and premature atherosclerosis in acromegaly. SUBJECTS Forty-five patients with acromegaly and 30 sex- and age-matched he althy subjects were included in this study: 30 patients were studied at the diagnosis of acromegaly and were in active disease (GH 59.3 +/- 10.2 mU/I, IGF-I 733 +/- 57.6 etag/l) while 15 patients were studied after surgery an d/or radiotherapy and were cured from the disease (GH 4.5 +/- 0.7 mU/l, IGF -I 172.3 +/- 16.9 mug/l). METHODS Body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP), serum total, LDL- and HDL-cholesterol, triglycerides, and fibrinogen levels, prothrombin time (PT), activated partial thrornboplastine time (AP TT), glucose and insulin levels (fasting and after glucose load) were measu red In all patients and controls. By echodoppler ultrasonography, blood sys tolic (SPV) and diastolic (DPV) peak velocity, and resistance index (RI) we re measured at both common and internal carotid arteries where presence, si ze and location of atherosclerotic plaques were evaluated by B-Mode ultraso nography. Intima-media thickness (IMT) of both common carotids was measured by M-Mode ultrasonography. RESULTS SBP, but not DBP, was significantly higher in patients with active disease than in cured patients and controls (P = 0.003). Hypertension was f ound in nine (30%) patients with active disease, in two (13.3%) of those cu red from acromegaly and In none of controls (chi (2) = 10.81, P < 0.004). P asting blood glucose levels were significantly higher both in patients with active disease and in those cured from the disease than in controls (P < 0 .001). Circulating insulin levels were significantly higher in patients wit h active disease than in cured patients and controls (P < 0.001) and in cur ed patients than in controls (P < 0.001). Glucose tolerance abnormalities w ere found in 13 (43.3%) patients with active disease, in four (26.6%) patie nts with inactive disease and in four controls (13.3%) (chi (2) = 6.71, P = 0.03). Total blood cholesterol levels were similar in the three groups, LD L-cholesterol and triglycerides levels were significantly higher, whereas H DL-cholesterol levels were significantly lower both in patients with active disease and in those cured from the disease than in controls (P < 0.001). Serum fibrinogen levers were significantly higher both in patients with act ive disease and in those cured from the disease than in controls (P < 0.001 ). No difference was found in PT and APTT levels among the three groups. At the level of right and left common carotid arteries, IMT was significant ly higher both in patients with active disease and in those cured from the disease than in controls (P < 0.001). Both right and left SPV, but not DPV, were significantly higher in patients with active disease than in those cu red from the disease and in controls (P < 0.01). Well defined carotid wall plaques were detected in two patients (6.6%) with active disease, in one pa tient cured from the disease (6.6%) and In two controls (6.6%). At the leve l of right and left internal carotid arteries, SPV, DPV and RI were similar among the three groups. Well defined carotid wall plaques were detected in three patients with active disease (10%), two patients cured from the dise ase (13.3%) and in one control (3.3%). CONCLUSIONS A significant increase of IMT of both common carotid arteries w as observed in patients with active acromegaly, this was also found in thos e cured from acromegaly. However, the prevalence of well defined carotid pl aques was not increased in both groups of patients with acromegaly as compa red to controls. On this basis, heart more than vessels seems to be affecte d by chronic GH and IGF-I excess in acromegaly.