IGF1 and atherosclerosis: Although some anti-atherogenic effects of IGF-1 on the endothelium have also been observed in acromegaly, as demonstrated by the lower than expected extent of atherosclerosis (i.e. lower IMT, based on risk factors, compared to controls) in active acromegaly patients [230], the pro-atherosclerotic and pro-inflammatory effects seemed to predominate on the longer term [108].