Intriguingly, in acromegaly, the concomitant presence of additional classical cardiovascular risk factors, such as smoking, sleep apnea, insulin resistance, hyperglycemia, dyslipidemia, and excess body weight, seem to have a greater influence on the development of coronary disease and atherosclerosis, rather than chronic and long-term exposure to GH/IGF-I excess (68). This evidence concerns the gene IGF1 and metabolic syndrome.