Cardiovascular risk in women with nonclassical congenital adrenal hyperplasia

Fernanda Cavalieri Costa; Larissa Garcia Gomes; Thais Martins de Lima; Luiz Aparecido Bortolotto; Valeria Hong; Renata Verardino; Manoel de Souza Rocha; Serli Kiyomi Nakao Ueda; Mirela Costa de Miranda; Heraldo Possolo de Souza; Ana Claudia Latronico; Berenice Bilharinho Mendonca; Tania A S S Bachega

doi:10.1210/clinem/dgae155

Cardiovascular risk in women with nonclassical congenital adrenal hyperplasia

J Clin Endocrinol Metab. 2024 Mar 11:dgae155. doi: 10.1210/clinem/dgae155. Online ahead of print.

Authors

Affiliations

¹ Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
² Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
³ Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.
⁴ Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

PMID: 38466890
DOI: 10.1210/clinem/dgae155

Abstract

Context: The outcomes related to cardiovascular risk (CVR) in patients with nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids (GCs) or oral contraceptive pills.

Objectives: to analyze CVR by markers of atherosclerosis in females with nonclassical form according to therapeutic options.

Design and setting: a cross-sectional study at a tertiary center.

Patients and methods: Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into: G1 (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day); G2 (n = 19) with oral contraceptive pills; and G3 (30 matched controls). CVR was analyzed through serum lipids, HOMA-IR, inflammatory cytokines levels and quantitative image evaluations (pulse wave velocity-PWV, endothelial function by flow mediated dilatation-FMD, carotid intima media thickness-CIMT and visceral fat-VAT by abdominal tomography.

Results: There were no statistically significant differences in BMI, HOMA-IR, HDL-cholesterol, or triglyceride levels among groups (p > 0.05). Serum interleukin-6 levels were higher in G1 than in G2 (p = 0.048), and interleukin-8 levels were higher in G1 than in G2/3 (p = 0.008). There were no statistically significant differences in VAT, PWV, FMD or CIMT among groups (p > 0.05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes.

Conclusion: Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and 8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.

Keywords: cardiovascular risk; carotid intima media thickness; endothelial function; nonclassical congenital adrenal hyperplasia; pulse wave velocity; visceral fat.