Women with Inactive Cushing’s Are Still at High Risk of a Heart Disorder, Study Finds

Premenopausal women whose Cushing’s syndrome is in remission are at high risk of having a heart problem even if they don’t have a cardiovascular disease, a study shows.

The research, “Translational evidence of prothrombotic and inflammatory endothelial damage in Cushing Syndrome after remission,” was published in the journal Clinical Endocrinology.

Excessive levels of glucocorticoids such as cortisol are the hallmark of Cushing’s. They are associated with a high risk of a developing a cardiometabolic disease that can lead to death. A cardiometabolic disease can involve either heart problems or metabolism problems like diabetes.

Scientists have linked high levels of glucocorticoids to a number of conditions that increase the risk of a person developing a heart problem. These conditions include insulin-resistant obesity, reduced glucose tolerance, diabetes, high blood pressure, high levels of fats known as lipids, and problems with blood clotting.

New studies have shown that some features of Cushing’s syndrome remain after a patient achieves remission. A high risk of a heart problem is one. It can last up to five years after remission. This may be due to a patient being obese, having high blood pressure or cholesterol levels, or having inflammation.

In addition, Cushing’s patients who are in remission can have heart damage that is not associated with their disease.

Researchers wanted to determine which factors contribute to Cushing’s patients being at risk of a heart problem. Their study covered patients whose Cushing’s syndrome was active, patients whose disease was in remission, and healthy people.

The first part of the two-part study was determining patients’ cardiometabolic profile. This included looking at markers of endothelial cell damage or dysfunction. Endothelial cells, which line blood vessels, become damaged when a person has a cardiovascular disease.

This part of the study showed that patients with an active case of Cushing’s were more likely to have a cardiometabolic disease than healthy patients. Interestingly, both those with an active case of Cushing’s and those in remission had higher levels of inflammatory factors than healthy people. They included hs-CRP, a protein that scientists say signals a major risk of a heart problem.

In the second part of their study, researchers exposed patients’ endothelial cells to the patients’ blood serum to see if the cells would generate an inflammatory response. Serum is the part of the blood that contains antibodies and other immune system-related factors.

Researchers discovered that endothelial cells exposed to the serum of patients with either active or inactive Cushing’s cases had higher levels of the inflammation-related proteins VCAM-1 and VWF than healthy people did. The two factors play a role in endothelial damage response.

The team concluded that the blood serum of premenopausal women with Cushing’s that is in remission, and who do not have a heart disease, contains factors that can trigger blot clots and inflammation, which “could increase cardiovascular risk.”