***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We studied premature atherosclerosis with carotid Doppler ultrasonography in active acromegaly before and after treatment . Patients ( n = 27 ) with active acromegaly and 12 age- , gender- , and body mass index-matched healthy individuals were included in the study . Carotid intima – media thickness was decreased significantly in the inactive group after treatment ( median : 0.6 mm , interquartile range [ IQR ] : 0.55 - 0.80 ] ) when compared with the active group ( median : 0.9 mm [ IQR : 0.75 - 1.15 ] , P < .0001 ) , but there was no significant difference between the inactive and control groups . There was a correlation between homeostasis model of assessment –insulin resistance ( P = .01 , r = .41 ) and growth hormone ( GH ; P < .0001 , r = .46 ) . In conclusion , premature atherosclerosis was demonstrated in active acromegaly patients probably as a consequence of insulin resistance and direct vascular effects of GH and /or insulin-like growth factor 1 BACKGROUND Acromegaly is known to be associated to vascular damage characterized by an increase of vascular wall thickness and an impairment of vascular function . AIM The aim of this study was to evaluate the effect of medical treatment with the GH receptor antagonist pegvisomant on vascular structure and function in acromegalic patients resistant to somatostatin analogues .  PATIENTS Ten patients ( 4 males and 6 females , 28 - 58 yr ) and 20 sex- , age- , and body mass index-matched healthy controls entered the study . All patients were treated for 18 months with pegvisomant at doses ranging from 10 to 40 mg/day . OUTCOME MEASURES Primary outcome measures were measurement of carotid arteries intima-media thickness ( IMT ) , and brachial arteries flow mediated dilation ( FMD ) ; secondary outcome measures were blood pressure , blood glucose and lipids levels . RESULTS Carotid arteries maximal IMT was significantly higher in patients than in controls at baseline ( 1.18±0.59 vs 0.69±0.13 , p=0.001 ) and slightly , but not significantly , decreased after treatment ( 0.97±0.17 ) . Brachial arteries FMD was significantly lower in patients than controls at baseline ( 7.5±2.5 vs 13.1±1.4 , p<0.001 ) and significantly increased after treatment ( 8.8±3.7 , p=0.016 ) . Systolic ( SBP ) and diastolic ( DBP ) blood pressure values , serum glucose and insulin levels and homeostasis model assessment ( HOMA ) index were higher , whereas HDL-cholesterol levels were lower in patients than controls at baseline . After treatment , SBP and DBP , as well as serum glucose and insulin levels and HOMA index significantly decreased whereas no significant change was found in serum lipid profile . CONCLUSIONS The results of the current study suggested that long-term treatment with pegvisomant induced a slight reduction of carotid arteries wall thickness and a significant improvement of brachial arteries vascular function in patients with acromegaly resistant to somatostatin analogues UNLABELLED Vascular changes are common in acromegaly ( ACM ) . Current therapies can normalise the levels of both growth hormone ( GH ) and insulin-like growth factor ( IGF1 ) . OBJECTIVE To establish whether the ACM vascular changes in patients with effectively managed disease are different from those in patients with an active condition . METHODS 64 ACM patients were tested for serum GH ( r and om and during an oral glucose tolerance test ) and IGF1 . Ultrasonography of the right common carotid ( RCC ) explored structural ( the carotid diameter and intima-media thickness index ( IMT ) ) and functional ( the augmentation index ( AIx ) , elastic modulus ( Ep ) , and local pulse wave velocity ( PWV ) ) arterial parameters in the ACM patients ( groups A and B ) and an age- and sex-matched control group of 21 patients without acromegaly ( group C ) . RESULTS The ACM patients were divided into 2 subgroups that had similar cardiovascular risk factor profiles : A ( n=10 , with controlled ACM ) , and B ( n=54 , with active ACM ) . The AIx was higher in groups A ( 27.7 % [ 2.2 - 54.3 ] ) and B ( 20.0 % [ - 38.2 - 97.1 ] ) than in group C ( 3.5 % [ - 11.3 - 31.1 ] ) , p=0.01 and 0.002 , respectively . The group B patients presented with poorer functional carotid wall parameters than the control subjects : Ep-95.5 [ 33 - 280 ] KPa vs. 77.5 [ 39 - 146 ] KPa , p=0.01 ; and PWV-6 [ 3.6 - 10.4 ] m/s vs. 5.4 [ 3.9 - 7.2 ] m/s , p=0.03.The ACM patients had greater RCC diameters ( 6.4 ± 0.6 mm vs. 5.7 ± 0.6 mm , p<0.001 ) and IMT values ( 0.72 ± 0.13 mm vs. 0.58 ± 0.08 mm , p<0.001 ) than the subjects in group C. CONCLUSIONS Both the controlled and active ACM patients showed structural arterial changes . After 1 year of disease control , the patients with controlled ACM showed improvements in the functional , but not the structural , arterial parameters compared with the patients with an active condition OBJECTIVE Transsphenoidal surgery results in biochemical remission of acromegaly in 45–80 % of patients ; however , few studies have addressed the impact of transsphenoidal surgery on cardiovascular function in acromegalic patients . The aim of this prospect i ve study was to investigate the effects of postoperative GH/IGF‐I normalization on echocardiographic parameters and blood pressure ( BP ) in a series of patients with active acromegaly Objective : The aim of this study was to assess flow-mediated dilatation ( FMD ) of the brachial artery in patients with acromegaly . Subjects and Methods : We prospect ively evaluated 25 patients with acromegaly ( 14 females , 11 males ; aged 42 ± 12 years ; growth hormone ( GH ) levels 34 ± 14 ng/ml ) and 27 control subjects ( 15 females , 12 males ; aged 45 ± 8 years ; GH levels 3 ± 1.5 ng/ml ) . The patients and controls were matched for age , gender , body mass index , cigarette smoking , blood pressure , lipid levels , diabetes mellitus , hypertension , and its duration . Endothelial function , measured as FMD of the brachial artery using ultrasound , was calculated in the 2 groups . The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery . Results : The FMD was lower in patients with acromegaly ( 9.97 ± 3.5 % ) than in controls ( 16.1 ± 3.4 % ) , and the difference was statistically significant ( p = 0.0001 ) . Conclusion : Endothelial dysfunction may develop in the pre clinical phase of atherosclerosis in patients with acromegaly . Endothelium-dependent FMD may be impaired in acromegalic patients , and measurement of endothelial function may identify high-risk individuals earlier OBJECTIVE To evaluate the effect of a 6-month treatment with slow-release lanreotide ( LAN ) on cardiovascular risk and atherosclerosis in 24 normotensive patients with active acromegaly ( GH=67.4 + /- 12.6 mU/l , IGF -- I=866.0 + /- 55.8 microg/l ) and 24 healthy subjects sex- , age- and body mass index-matched with the patients ( as controls ) . DESIGN Open , prospect i ve , multicenter . METHODS The following were measured before and after 6 months of LAN treatment ( dose 60 - 90 mg/month ) : fasting GH , IGF-I , LDL , HDL and total cholesterol , triglyceride , glucose , glycosylated hemoglobin , insulin and fibrinogen levels , intima-media thickness ( IMT ) and blood systolic and diastolic peak velocity ( SPV and DPV respectively ) in both common carotids . RESULTS At study entry , insulin , total and LDL cholesterol , triglyceride and fibrinogen levels were higher while HDL cholesterol levels were lower in patients than in controls . At the right ( 0.88 + /- 0.04 vs 0.77 + /- 0.03 mm , P=0.05 ) and left ( 0.93 + /- 0.03 vs 0.78 + /- 0.02 mm , P=0.01 ) common carotid IMT was significantly higher in patients than in controls ; 12 patients and two controls showed an IMT of > or = 1 mm ( chi(2)=8.2 , P=0.004 ) . After 6 months of LAN treatment , disease control was achieved in 15 patients ( 62.5 % ) . Insulin , triglyceride and fibrinogen levels were significantly decreased , and a trend toward a decrease of IMT in the right ( from 0.90 + /- 0.05 to 0.78 + /- 0.04 mm , P=0.06 ) and left ( from 0.95 + /- 0.04 to 0.84 + /- 0.04 mm , P=0.06 ) common carotid arteries was observed only in patients with disease control , while SPV and DPV did not change . CONCLUSIONS LAN treatment for 6 months significantly lowered GH , IGF-I , insulin and fibrinogen levels and reduced IMT of both common carotid arteries in normotensive patients with acromegaly It is well established , that the increased mortality in patients with acromegaly is due to cardiac diseases . Cardiomyopathy is the predominant cardiac alteration in patients with acromegaly . There are less data about coronary heart disease or coronary calcifications .  Electron beam computed tomography ( EBCT ) is the st and ard imaging modality for identification of coronary artery calcifications ( CAC ) and can determine the extent and severity of coronary atherosclerosis . Coronary risk was evaluated by the Framingham risk score ( FRS ) . The prospect i ve study included 30 patients with acromegaly ( mean age 53+/-14 year ; 16 females , 14 males ; BMI 28.1+/-3.6 kg/m ( 2 ) ; mean+/-SD ) , 12 patients had active disease ( IGF-1 751+/-338 microg/L ; GH 25.6+/-36.4 microg/L ) , 9 were well-controlled ( IGF-1 157+/-58 microg/L ; GH 1.8+/-1.1 microg/L ) under somatostatin analogue octreotide ( n=5 ) , dopamine agonists ( n=2 ) , and the GH receptor antagonist pegvisomant ( n=2 ; GH levels were not determined in this subgroup ) and 9 were cured IGF-1 ( 148+/-57 microg/L ; GH 0.5+/-0.2 microg/L ) . Increased left ventricular muscle mass index ( LVMI > 132 g/m ( 2 ) ) was focused in 53 % , hypercholesterinemia in 63 % , hypertension in 43 % , diabetes mellitus/impaired glucose tolerance in 27 % , and smokers in 53 % ( pack per year 9+/-15 yr ) . For quantification of CAC the EBCT was used and the Agatston calcium score was determined . Results were composed to established age and sex adjusted percentile distribution of CAC . CAC was present in 53 % , high CAC score ( 75 ( th ) percentile ) in 37 % and were categorized as cardiovascular high risk patients . FRS was related to the CAC score ( p=0.008 , r (2)=0.22 ) and the disease duration ( p=0.002 , r (2)=0.29 ) . The CAC score correlated with LVMI ( p=0.02 , r (2)=0.17 ) , the disease duration of acromegaly ( p=0.004 , r (2)=0.36 ) , and the FRS ( p=0.008 , r (2)=0.22 ) . Patients with a high CAC score had a longer disease duration of 9.6+/-4.7 versus 5.4+/-2.8 years with CAC<75 ( th ) percentile ( p=0.02 ) . In summary , the disease duration and consequently the accompanying metabolic disorders appear to influence the degree of CAC in patients with acromegaly . The observations underline the importance of early and sufficient treatment of acromegaly in high risk patients BACKGROUND Data on coronary heart disease ( CHD ) are scanty and matter of argument in acromegalic patients . OBJECTIVE 
    Output:
    
Conclusions IMT , FMD and arterial stiffness are impaired in acromegaly showing that these patients may be at increased risk of atherosclerosis .
In patients with active disease these pre clinical markers of atherosclerosis are worse compared to patients with inactive disease but the role of diabetes and hypertension is prevailing on growth hormone excess