Background: Non-functional adrenal incidentaloma (NFAI) is associated with an increased risk of adverse cardiometabolic outcome. Identifying predictors of atherosclerotic cardiovascular disease (ASCVD) may enable more appropriate management strategies in patients with NFAI. We aimed to investigate the body composition parameters and ASCVD risk in patients with NFAI.

Methods: Eighty patients with NFAI and 80 controls matched for age, gender and body mass index (BMI) were included. ASCVD risk was assessed on Framingham Risk Score (FRS) and American Heart Association /American College of Cardiology (AHA/ACC) score. Body composition was evaluated using a segmental body composition analyzer.

Results: There were no significant differences in age, gender, blood pressure or body composition parameters between the two groups. Patients with NFAI had higher FRS and AHA/ACC scores than controls (p=0.017, p=0.024, respectively). In patients with NFAI, independent predictors for FRS were serum cortisol level after 1 mg dexamethasone suppression test (DST) and waist/hip ratio (WHR), while independent predictors for AHA/ACC score were serum cortisol level after 1 mg DST, WHR and fasting plasma glucose (FPG), in various multivariate linear regression models.

Conclusions: FRS and AHA/ACC scores may be useful in determining ASCVD risk in patients with NFAI, and serum cortisol level after 1 mg DST is an independent predictor of ASCVD in these patients, even in the absence of hypercortisolism.