Endocrine Abstracts

The association between acromegaly and increased cardiovascular morbidity and mortality is widely recognised. The aim of this retrospective multicentric study is to evaluate the impact of different therapeutic approaches on the progression of cardiovascular risk (CVR) in acromegalic patients. At diagnosis and last follow up (follow up time of 13 ± 8 years),we assessed BMI, blood pressure, glycaemic and lipid profile, GH and IGF1 levels in 199 patients with acromegaly (116 females), which received at least a medical treatment during follow up. To assess CVR, we used the Italian Heart Project Score (IHPS-CVR) and Framingham Score (FS-CVR), which were calculated both at baseline and last follow up. During follow up, major adverse cardiac events (MACEs) were recorded in 16 subjects. We divided patients in two groups according to received treatment: 60 patients treated only with medical therapy (MT) and 139 with a combination of medical therapy, neurosurgery and, in some cases, radiotherapy (MT + NS ± RT). At baseline, MT patients were older (P < 0.001), with higher prevalence of diabetes and hypertension (P < 0.001), and had greater IHPS-CVR (P 0.002) and FS-CVR values (P = 0.004), whereas the MT + NS ± RTgroup showed higher GH levels (P = 0.023) and largest pituitary adenomas (P < 0.001). To adjust for these differences in the comparison of the 2 groups, we computed a propensity score using the clinical characteristics that differed at baseline as covariates for a logistic regression model. With an inverse probability weighting (IPW) we created a focused sample that allows for unbiased estimates of treatment effects. In our cohort, the estimated time-related profiles of CVR remain approximately constant over time in both groups. In addition, MT and MT + NS ± RT groups appeared comparable regard to both IHPS-CVR and FS-CVR without any statistically significant differences at baseline (IHPS-CVR IC 95 % : –4.38 + 2.68; FS-CVR IC 95 % : –7.35 + 9.42) and at 10 years of follow up (IHPS-CVR IC 95 %: –5.36 + 2.95; FS-CVR IC 95 % : –9.92 + 8.12). Furthermore, MT and MT + NS ± RT groups did not significantly differ for MACEs incidence rate (P 0.11). Finally, univariate analysis adjusted for gender, age and IPW showed that diastolic hypertension (P 0.008) and disease control (P 0.011) were the most significant risk factors for MACEs. In conclusion, this study suggests that treatment of acromegaly is able to slow the CVR progression although increasing age during follow-up, regardless the type of the therapeutic approach. The disease control significantly impacts on the cardiovascular risk, but also diastolic hypertension control could be an important therapeutic target to reduce the MACEs incidence.