Treating Cushing's doesn't spare heart

To be treated implies a certain finality — the affliction has been identified, the elixirs and antidotes cast, the immediate symptoms have retreated and dissipated. But as is often the case in the struggle for health, exit wounds and traces are difficult to evade.

For patients with Cushing’s disease, especially those who were diagnosed during their later years or had prolonged exposure to excess cortisol, successful treatment does not levy much protective merit against the development of cardiovascular disease, a new study contends.

"The longer patients with Cushing's disease are exposed to excess cortisol and the older they are when diagnosed, the more likely they are to experience these challenges," said Eliza B. Geer, MD, of Mount Sinai Medical Center and lead author of the study, in a news release. "The findings demonstrate just how critical it is for Cushing's disease to be diagnosed and treated quickly. Patients also need long-term follow-up care to help them achieve good outcomes."

Geer and company found, for instance, that patients cured of Cushing’s disease who were depressed when symptoms first arose had higher mortality rates and an increased risk for cardiovascular complications. Furthermore, men were discovered to be more susceptible to such disheartening conditions than women, and those patients with both Cushing’s disease and diabetes were amply more prone as well. Researchers reviewed the patient records of 346 patients with Cushing’s disease treated between 1980 and 2011; the average exposure was estimated to be a period of 40 months.

Geer extended the same heightened risk for cardiovascular disease to non-Cushing’s patients who take steroid medication. Those who are administered high doses of prednisone, hydrocortisone or dexamethasone are hence introduced to elevated cortisol levels and therefore on par with Cushing’s sufferers regarding cardiovascular trepidation.

"While steroid medications are useful for treating patients with a variety of conditions, the data suggests healthcare providers need to be aware that older patients or those who take steroid medications for long periods could be facing higher risk," she concluded. "These patients should be monitored carefully while more study is done in this area."

The study is to be published in an upcoming edition of the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.