Rethinking cardiovascular risk in acromegaly

Abstract

The natural history of acromegaly has changed substantially over the past few decades. The wider availability of diagnostic tools, advances in pituitary surgery, and the development of effective pharmacological therapies have enabled an increasing number of patients to achieve biochemical disease control and experience improved life expectancy. Paradoxically, this therapeutic success has shifted attention toward an equally important challenge: determining the extent to which endocrine control modifies cardiovascular risk and identifying the strategies required to effectively reduce cardiovascular morbidity and mortality in these patients.

Chronic excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) triggers a complex cascade of structural, metabolic, and functional alterations that affect virtually every component of the cardiovascular system. Hypertension, insulin resistance, diabetes mellitus, dyslipidemia, acromegalic cardiomyopathy, valvular heart disease, and cardiac arrhythmias should not be regarded as isolated entities, but rather as manifestations of a common pathophysiological process that evolves gradually and whose effects may begin many years before the clinical diagnosis is established. This insidious progression helps explain why some patients continue to experience cardiovascular complications even after achieving adequate hormonal control.