Table 1.
Cardiometabolic risk factors and classical congenital adrenal hyperplasia: references from 2015 to present.
| First Author Year | CAH Study Population | Age, Sex | Main Outcomes | Conclusions |
|---|---|---|---|---|
| Akyürek, N. 2015 (21) | N = 25 | 5-15 years64% Female | CAH patients had increased BMI, insulin resistance, diastolic blood pressure (DBP) and carotid intima-media thickness (cIMT). 24% of patients exhibited arterial hypertension, and 20% had nocturnal hypertension. CIMT was higher in patients with nocturnal hypertension. | Classical CAH patients exhibit subclinical cardiovascular disease (CVD) with associations with hypertension. |
| Falhammar, H. 2015 (20) | N = 588 | 0-40 years57% Female | Increased prevalence of hypertension, obesity, hyperlipidemia, and diabetes observed in CAH patients vs. controls. | CAH was associated with higher rates of cardiovascular and metabolic morbidity. |
| Kim, M.S. 2015 (15) | N = 28 | 15.6 ± 3.2 years | Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT : SAT were higher in CAH patients vs. controls. | Increased prevalence of unfavorable abdominal fat distribution could affect CVD risk in CAH. |
| 54% Female | ||||
| Marra, A.M. 2015 (22) | N = 20 | 13.6 ± 2.5 years | CAH patients had increased BMI, waist-to-height ratio and HOMA index vs. controls, and high systolic blood pressure (SBP) and decreased workload at peak exertion. | CAH patients can exhibit decreased exercise tolerance due to subclinical cardiovascular abnormalities. |
| 50% Female | ||||
| Rodrigues, T.M.2015 (23) | N = 40 | 5-20 years | Increased cIMT was observed in CAH youth, who also presented with increased BMI and SBP compared to controls. | Increased cIMT, BMI and SBP from a young age suggests increased CVD risk in CAH. |
| 80% Female | ||||
| Bonfig, W. 2016 (11) | N = 716 | 3-18 years | Prevalence of hypertension in the study population was 12% and was more prominent in younger CAH patients. | CAH patients have increased risk for hypertension. However, the prevalence decreases with age. |
| Kim, M.S. 2016 (24) | N = 20 | 16 ± 3.3 years | Mean cIMT was correlated with serum 17-hydroxyprogesterone (17-OHP) and androstenedione levels in CAH patients. No cIMT differences observed between CAH patients and controls. | Findings suggest a link between hyperandrogenism and subclinical atherosclerosis in CAH patients. |
| 50% Female | ||||
| Metwalley, K.A. 2016 (25) | N = 32 | 13.6 ± 2.5 years | Higher levels of highly-sensitive C-reactive protein (hs-CRP) and circulating endothelial cells in CAH patients, as well as left ventricular hypertrophy and prolonged mitral deceleration time. | Children with CAH present with markers of endothelial damage, subclinical atherosclerosis and left ventricular dysfunction. |
| 56% Female | ||||
| Takishima, S. 2016 (26) | N = 29 | Pediatric | Adiposity rebound (AR) in CAH patients occurred before the age of 4 years, which is earlier than the general Japanese population. | Lower BMI at birth is associated with earlier AR in CAH patients. |
| 52% Female | ||||
| Ariyawatkul, K. 2017 (27) | N = 21 | 15.2 ± 5.8 years | Increased waist-to-hip ratio in patients with classical CAH. | Adolescents with CAH have increased risk of visceral obesity and cardiometabolic risk factors. |
| 81% Female | ||||
| Mooij, C.F. 2017 (12) | N = 27 | 8-16 years | Elevated BMI and blood pressure observed in CAH patients, with seven patients categorized as overweight and four as obese. | Elevated BMI and blood pressure in CAH patients from a young age increases their CVD risk. |
| Sarafoglou, K. 2017 (7) | N = 194 | ≥ 2 years | Children with CAH had increased risk for early onset obesity. AR occurred earlier at 3.3 years old. | Careful monitoring of hydrocortisone dosing during early childhood is needed to prevent increased weight gain and early AR in CAH. |
| 52% Female | ||||
| Wierzbicka-Chimel, J. 2017 (28) | N = 19 | 23.7 ± 3.8 years | CAH patients had decreased flow mediated dilation (FMD), cIMT, and common femoral artery IMT (fIMT). | CAH patients on long-term glucocorticoid therapy demonstrate decreased FMD and subclinical changes in left ventricular diastolic function. |
| 37% Female | ||||
| Metwalley, K.A. 2018 (29) | N = 36 | 5-12 years | CAH patients had elevated serum homocysteine levels, thicker cIMT, and high left ventricular mass. | Elevated homocysteine levels in CAH patients suggests risk for subclinical atherosclerosis. |
| 72% Female | ||||
| Tamhane, S. 2018 (30) | Meta-Analysis | Pediatric and Adult | CAH patients had increased SBP, DBP, insulin resistance, and cIMT, but no evidence of morbidity or mortality due to cardiac events. | CAH patients have a high prevalence of cardiometabolic risk factors, but evidence has been lacking for actual morbidity or mortality. |
| Improda, N. 2019 (31) | Review Paper | Children and Adolescents | CAH patients presented with obesity, insulin resistance, hypertension, increased IMT and subclinical cardiac dysfunction from a young age. | Exposure to excess glucocorticoids, mineralocorticoids, and androgens may contribute to the development of cardiovascular changes. |
| Metwalley, K.A. 2019 (32) | N = 36 | 13.7 ± 2.4 years | CAH patients had greater epicardial fat thickness (EFT), cIMT, and left ventricular mass vs. controls. | Increased EFT suggests an increased risk of developing left ventricular dysfunction and subclinical atherosclerosis in CAH. |
| 69% Female | ||||
| Vijayan, R. 2019 (33) | N = 52 | 3-21 years | CAH patients had a higher BMI, mean DBP, and greater insulin resistance vs. controls. | CAH youth have higher CVD risk and reduced quality of life despite adequate management. |
| (Median 12y) | ||||
| 73% Female | ||||
| Bhullar, G. 2020 (34) | N = 42 | 45.2% Female | CAH patients had earlier AR at 3.4 ± 1.3 years overall, and patients with obesity had an earlier AR vs. lean patients. Earlier AR predicted higher BMI-z during childhood, as well as increased central obesity and total body fat in adolescence. | Early AR can be used as a marker for disease severity and cardiometabolic risk in youth with classical CAH. |
| Gomes, L.G. 2020 (35) | Review Paper | Pediatric and Adult | Several studies showed increased prevalence of obesity, abnormal body composition, insulin resistance, and hypertension in CAH patients. | Despite an increased prevalence of cardiovascular markers, CVD remains unknown, and comparison of varying glucocorticoid regimens is needed. |
| Paizoni, L. 2020 (36) | N = 90 | 18-62 years | IMT was the same between CAH patients and controls. Only one patient in the cohort fulfilled the criteria for metabolic syndrome. | Though there is a high prevalence of insulin resistance and obesity in CAH patients, rarely do adults with CAH develop metabolic syndrome. |
| (Median 29y) | ||||
| 57% Female | ||||
| Farghaly, H.S. 2021 (37) | N = 40 | 14.8 ± 2.6 years | CAH patients had elevated serum neopterin levels, decreased brachial FMD %, and normal cIMT vs. controls. | CAH patients have endothelial dysfunction as noted by elevated serum neopterin levels, which can explain vascular pathology seen in CAH. |
| 70% Female | ||||
| Hasemi Dehkordi, E. 2021 (38) | N = 78 | 9.40 ± 4.09 years | 17-OHP serum concentrations were positively correlated with DBP and BMI in CAH patients. | Elevated 17-OHP, a marker of poor disease management, may be correlated to increased prevalence of CVD risk factors in CAH patients. |
| 53% Female | ||||
| Torky, A. 2021 (14) | N = 57 | Pediatric andAdult (longitudinal) | CAH patients exhibited a higher prevalence of obesity, hypertension, insulin resistance, and low HDL that began prior to age 10. 23 patients fit metabolic syndrome criteria at 1+ visits. Increased obesity in childhood was seen with maternal obesity. | Higher prevalence of CVD risk factors is seen in CAH patients at a young age and is associated with treatment and familial factors. |