Search

Acromegaly is associated with cardiovascular disease, the principal cause of increased mortality. Direct cardiac effects of GH/IGF-1 are cardiomyocyte growth and cardiac contractility, cardiac remoddeling. Other important risk factors in acromegaly are hypertension, valvular diseases, arrhytmias. Older patients with long-term uncontrolled disease may develop congestive heart failure as end-stage of acromegalic cardiomyopathy. Early treatment of acromegaly is essential for evolution and prognosis of cardiovascular complications.

Obesity is a globally expanding disorder and is the result of the interaction of genetic and environmental factors with the participation of social, behavioural, cultural, physiological, metabolic, and genetic influences. Obesity has profoundly negative effects on the health of the population and induces associated comorbidities such as hypertension, hyperlipidaemia, hyperinsulinemia / insulin resistance. There is ample evidence that obesity causes hypertension, cardiovascular disease, type 2 diabetes, cancer and chronic kidney disease, and the association of obesity with hypertension and other cardiovascular risk factors significantly increases the risk of cardiovascular events.

“Essential” hypertension is related to multiple mechanisms that affect cardiac output and peripheral resistance and is a consequence of the interaction between external factors and genetic factors. Neuro-hormonal factors are essential in the pathophysiology of hypertension and among them the renin-angiotensin-aldosterone system (RAAS) has a main role in the physiological and pathological response of the cardiovascular system. RAAS functions as an endocrine system, but also has paracrine and autocrine functions in many tissues and organs. RAAS regulates extracellular fluid volume and peripheral resistance via systemic and local actions in various tissues. RAAS also participates in endothelial dysfunction, inflammation and vascular fibrosis, cardiac fibrosis and cardiovascular remodelling, with worsening hypertension and target organ injury. Aldosterone is involved in “essential” hypertension via discrete variations in the regulation of aldosterone synthesis in the absence of confirmed primary hyperaldosteronism. A complete evaluation of these systems is needed for a thorough understanding of hypertension.

Cardiovascular disease is a complex process that includes genetic, inflammatory and endocrine components. During the last decades, much emphasis has been given to cholesterol and lipids as the primary determinants in cardiovascular disease. However, many endocrine and biochemical factors are involved in the atherosclerosis process as well, both systemically and vascular. Multiple obvious data suggest that hormones are responsible for subtle cardiovascular changes long before the development of overt atherosclerotic. Much research remains to be done regarding the interaction between endocrine systems and their role in atherogenesis.

Cushing’s syndrome (CS) is a clinical condition resulting from chronic exposure to glucocorticoid excess. Hypercortisolism contributes significantly to the early development of systemic disorders by direct and/or indirect effects. Complications such as obesity, hypertension, diabetes, dyslipidemia, and hypercoagulability cause premature atherosclerosis and increase cardiovascular mortality. These associated abnormalities increase cardiovascular risk not only during the active phase of the disease but also long after the remission of hypercortisolism. Clinical management of these patients should be particularly careful and control of cardiovascular risk factors is necessary for a long period.

Summary Subclinical hypothyroidism (HSC) is a relatively common thyroid dysfunction, characterized by the increase of the thyroid stimulating hormone (TSH) in the presence of normal free thyroxine values. Thyroid hormones are known for the cardiovascular effects, and the consequences of HSC on the cardiovascular system have become the focus of many studies lately. There are clear indications of the relationship between HSC and cardiovascular risk factors such as hypertension, dyslipidemia and atherosclerosis; also, HSC is associated with metabolic syndrome, BMI increase and cardiac insufficiency. Therefore, many clinical trials investigate the benefits and risks of HSC treatment with L-thyroxine.