Gender-related differences in carotid atherosclerosis and flow-mediated dilation in patients with Cushing’s disease

Aim. Patients with Cushing's syndrome have a cardiovascular mortality rate four times higher than the general population. The purpose of this study was to establish any significant difference in cardiovascular morbidity evaluated by Intima-media Thickness (IMT) and endothelial dysfunction (FMD) among a group of patients with Cushing's syndrome and a control group matched for gender, age and classic risk factors for atherosclerosis. Methods. We retrospectively studied 63 patients (45 females and 18 males) with ACTH-dependent Cushing's syndrome. This group was matched and compared with a control group selected by their anthropometric and metabolic characteristics. All subjects underwent ultrasound of carotid arteries determining the related IMT and of brachial artery for FMD. Results. Cases presented greater IMT and lower FMD% compared with controls, particularly the women. When the two genders within the group of Cushing's patients were compared, we could find no significant differences in IMT or FMD between males and females. When these results were correlated with atherosclerotic risk factors, FMD was strongly reduced in female Cushing's patients by comparison with the female controls and it correlated closely with dyslipidemia and BMI. Among the males with Cushing's syndrome, the IMT and FMD findings correlated strongly with diabetes. Conclusion. Our retrospective case-control study indicates that Cushing's patients have a lower FMD and a higher carotid IMT, which correlate with their metabolic syndrome and are uninfluenced by gender. For this reason, it is important the control of their endothelial function to prevent atherosclerosis.