Cardiovascular Risk Factors in Patients with Addison's Disease: A Comparative Study of South African and Swedish Patients

• Published in: PloS one Vol. 9; no. 3; p. e90768
• Main Authors: Ross, Ian Louis, Bergthorsdottir, Ragnhildur, Levitt, Naomi, Dave, Joel Alex, Schatz, Desmond, Marais, David, Johannsson, Gudmundur
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.03.2014; Public Library of Science (PLoS)
• Subjects: Addison Disease - blood; Addison Disease - complications; Addison Disease - drug therapy; Addison's disease; Adiponectin; Adiponectin - blood; Adult; Advertising executives; Annan medicin och hälsovetenskap; Anthropometry; Anti-Inflammatory Agents - therapeutic use; Autoimmune diseases; Biology; Biomarkers - blood; Blood lipids; Blood pressure; Body mass; C-reactive protein; C-Reactive Protein - metabolism; Cardiac patients; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cholesterol; Clinical Medicine; Comparative studies; Cross-Sectional Studies; Diabetes mellitus; Endocrine disorders; Environmental factors; Female; Health aspects; Health risks; High density lipoprotein; Historical account; Humans; Hydrocortisone; Hydrocortisone - therapeutic use; Hypertension; Inflammation Mediators - blood; Klinisk medicin; Lipids; Lipids - blood; Lipoproteins (high density); Lipoproteins (low density); Low density lipoprotein; Low density lipoproteins; Male; Medical research; Medicine; Middle Aged; Minority & ethnic groups; Other Medical and Health Sciences; Patients; Risk analysis; Risk Factors; Serum lipids; South Africa; Sweden; Triglycerides; South Africa; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0090768

Patients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa. In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied. All patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1-2.46) versus 0.96 (0.74-1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93-5.45) versus 0.99 (0.57-2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus. South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.