Cardiovascular Risk in Women With Nonclassical Congenital Adrenal Hyperplasia

Abstract

Abstract Context The outcomes related to cardiovascular risk (CVR) in patients with the nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids or oral contraceptive pills. Objectives To analyze CVR by markers of atherosclerosis in females with the nonclassical form according to therapeutic options. Design and Setting A cross-sectional study at a tertiary center. Patients and Methods Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into group 1 (G1) (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day), group 2 (G2) (n = 19) treated with oral contraceptive pills, and group 3 (G3) (30 matched controls). CVR was analyzed through serum lipids, the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), inflammatory cytokines levels, and quantitative image evaluations [pulse wave velocity (PWV), endothelial function by flow-mediated dilatation (FMD), carotid intima media thickness (CIMT), and visceral fat (VAT) by abdominal tomography]. Results There were no statistically significant differences in BMI, HOMA-IR, high-density lipoprotein-cholesterol, or triglyceride levels among groups (P > .05). Serum interleukin 6 (IL-6) levels were higher in G1 than in G2 (P = .048), and interleukin 8 (IL-8) levels were higher in G1 than in G2/3 (P = .008). There were no statistically significant differences in VAT, PWV, FMD, or CIMT among groups (P > .05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes. Conclusion Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and IL-8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.