Cardiovascular and Metabolic Outcomes in Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

Shrikant Tamhane, Rene Rodriguez-Gutierrez, Anoop Mohamed Iqbal, Larry J. Prokop, Irina Bancos, Phyllis W. Speiser, Mohammad H Murad

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Individuals with congenital adrenal hyperplasia (CAH) require glucocorticoid therapy to replace cortisol and to control androgen excess. We sought to evaluate the effects of glucocorticoid therapy on cardiovascular and metabolic outcomes in individuals with CAH.

Methods: We searched bibliographical databases through January 2016 for studies evaluating cardiovascular risk factors in individuals with CAH treated with glucocorticoids compared with controls without CAH. We used a random-effects model to synthesize quantitative data.

Results: We included 20 observational studies (14 longitudinal, six cross-sectional) with a moderate to high risk of bias. The average dose of glucocorticoids (in hydrocortisone equivalents) was 9 to 26.5 mg/m2/d. In the meta-analysis (416 patients), compared with controls without CAH, individuals with CAH had increased systolic blood pressure [weighted mean difference (WMD), 4.44 mm Hg; 95% CI, 3.26 to 5.63 mm Hg], diastolic blood pressure (WMD, 2.35 mm Hg; 95% CI, 0.49 to 4.20 mm Hg), homeostatic model assessment of insulin resistance (WMD, 0.49; 95% CI, 0.02 to 0.96), and carotid intima thickness (WMD, 0.08 mm; 95% CI, 0.01 to 0.15 mm). No statistically significant differences were noted in fasting blood glucose, insulin level, glucose, or insulin level after 2-hour glucose load or serum lipids. Data on cardiac events were sparse, and most of the literature focused on surrogate outcomes.

Conclusion: Individuals with CAH demonstrate a high prevalence of cardiovascular and metabolic risk factors. The current evidence relies on surrogate outcomes. Long-term prospective studies are warranted to assess strategies for reducing cardiovascular risk in individuals with CAH.

Original languageEnglish (US)
Pages (from-to)4097-4103
Number of pages7
JournalThe Journal of clinical endocrinology and metabolism
Volume103
Issue number11
DOIs
StatePublished - Nov 1 2018

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Congenital Adrenal Hyperplasia
Glucocorticoids
Meta-Analysis
Blood pressure
Insulin
Hydrocortisone
Blood Pressure
Glucose
Androgens
Blood Glucose
Lipids
Observational Studies
Insulin Resistance
Fasting
Databases
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Cardiovascular and Metabolic Outcomes in Congenital Adrenal Hyperplasia : A Systematic Review and Meta-Analysis. / Tamhane, Shrikant; Rodriguez-Gutierrez, Rene; Iqbal, Anoop Mohamed; Prokop, Larry J.; Bancos, Irina; Speiser, Phyllis W.; Murad, Mohammad H.

In: The Journal of clinical endocrinology and metabolism, Vol. 103, No. 11, 01.11.2018, p. 4097-4103.

Research output: Contribution to journalArticle

Tamhane, Shrikant ; Rodriguez-Gutierrez, Rene ; Iqbal, Anoop Mohamed ; Prokop, Larry J. ; Bancos, Irina ; Speiser, Phyllis W. ; Murad, Mohammad H. / Cardiovascular and Metabolic Outcomes in Congenital Adrenal Hyperplasia : A Systematic Review and Meta-Analysis. In: The Journal of clinical endocrinology and metabolism. 2018 ; Vol. 103, No. 11. pp. 4097-4103.
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AU - Speiser, Phyllis W.

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AB - Background: Individuals with congenital adrenal hyperplasia (CAH) require glucocorticoid therapy to replace cortisol and to control androgen excess. We sought to evaluate the effects of glucocorticoid therapy on cardiovascular and metabolic outcomes in individuals with CAH.Methods: We searched bibliographical databases through January 2016 for studies evaluating cardiovascular risk factors in individuals with CAH treated with glucocorticoids compared with controls without CAH. We used a random-effects model to synthesize quantitative data.Results: We included 20 observational studies (14 longitudinal, six cross-sectional) with a moderate to high risk of bias. The average dose of glucocorticoids (in hydrocortisone equivalents) was 9 to 26.5 mg/m2/d. In the meta-analysis (416 patients), compared with controls without CAH, individuals with CAH had increased systolic blood pressure [weighted mean difference (WMD), 4.44 mm Hg; 95% CI, 3.26 to 5.63 mm Hg], diastolic blood pressure (WMD, 2.35 mm Hg; 95% CI, 0.49 to 4.20 mm Hg), homeostatic model assessment of insulin resistance (WMD, 0.49; 95% CI, 0.02 to 0.96), and carotid intima thickness (WMD, 0.08 mm; 95% CI, 0.01 to 0.15 mm). No statistically significant differences were noted in fasting blood glucose, insulin level, glucose, or insulin level after 2-hour glucose load or serum lipids. Data on cardiac events were sparse, and most of the literature focused on surrogate outcomes.Conclusion: Individuals with CAH demonstrate a high prevalence of cardiovascular and metabolic risk factors. The current evidence relies on surrogate outcomes. Long-term prospective studies are warranted to assess strategies for reducing cardiovascular risk in individuals with CAH.

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