OVERVIEW rationale and to suggest enlisting Cushing’s syndrome

OVERVIEW OF THE MEDICAL
LITERATURE ON THE TOPICThe intention of the paper is to give rationale and to suggest enlisting
Cushing’s syndrome (CS) amongst high cardiovascular (CV) risk conditions. A considerable
amount of data refers to several-fold amplified mortality in CS. The causes are
based on high occurrence of many CV risk factors in persons with CS (e.g., adiposity, arterial hypertension, dyslipidemia,
as well as diabetes mellitus /DM/). Therefore, practically all individuals with CS have correspondingly the metabolic syndrome
(MetSy), which is known as laden with high CV risk. Characteristically, in spite of the young average age, numerous of CS individuals dysplay
a ‘high’ or a ‘very high’ CV risk, with the risk of a major CV event of over
20% in the following ten years. Although DM is listed as a condition
with high cardiovascular risk CS
is not, despite the fact that the greater part of CS population
have either diabetes mellitus or diagnosed impaired glucose tolerance. CS is stated as a risk factor for aortic dissection
in current guidelines, and it should be named as a disease with high CV risk (alike
DM and chronic kidney disease) in the relevant guidelines, as well.

 

Key-Words: Cushing’s
syndrome, diabetes mellitus, arterial hypertension, metabolic syndrome, cardiovascular
risk factors.

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Chronic
corticosteroid administration (i.e. CS) is enlisted
in 2010 Guidelines as a risk factor (RF) for aortic dissection with lack of
detailed elucidation (1). Accordingly, what is evident both from common
medical sense, as well as from everyday practice (that CS should be considered
as a kind of high cardiovascular /CV/ risk) is not in Guidelines; nevertheless,
what is neither noticeable, nor common (that CS persons are predisposed to
aortic dissection) is a part of current Guidelines (1).

The intention of the paper is
to give rationale (from published medical literature) and to suggest enlisting
CS amongst high cardiovascular risk conditions.

 

OVERVIEW OF THE MEDICAL LITERATURE ON THE TOPIC

Exogenous (mostly iatrogenic) CS is
the repercussion of the applying of glucocorticoids or adrenocorticothropic
hormone (ACTH). Iatrogenic CS is nowadays definitely the most frequent form of all
forms of CS. In other words, as many as one percent of the populace is receiving corticosteroids
per os (even 3% of individuals over 70 years old ), plus individuals who
use other administration routes (e.g., inhalation, transdermal, intravenous,
intramuscular, intraarticular, rectal, etc) (2). While
endogenous form of CS is practically rare, a markedly high percentage (0.8-2%)
of the overall population has long-term/high-dose glucocorticoid therapy (3). Wei et al. examined exactly 68,781 persons who were on glucocorticoid therapy, as well as 82,202
controls with lack of earlier hospitalization for CV illness (more than 150,000 individuals in whole). Independently of known covariates, estimated
relative risk (adjusted rate ratio) for  CV events, was  2.56 (CI, 2.18-2.99) in individuals who
have received glucocorticoids in high doses (4). This population-based research demonstrates that individuals
who were treated with daily doses of glucocorticoids larger than 7.5 mg of
prednisolone (or dose equivalents of other glucocorticoids) during one to five years
of follow-up period, had significantly higher prevalence of all CV diseases, e.g.,
myocardial infarction, cardiac insufficiency, as well as cerebrovascular illness
(4).  Since
many individuals were administered corticosteroid therapy, it has a considerable
clinical relevance (5)