Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .
Effects of growth hormone administration on inflammatory and other cardiovascular risk markers in men with growth hormone deficiency. A randomized, controlled clinical trial.
BACKGROUND Growth hormone-deficient adults have increased cardiovascular mortality . Growth hormone replacement may affect cardiovascular risk . Inflammation plays an important role in atherosclerosis , and inflammatory markers are predictive of cardiovascular events . OBJECTIVE To investigate the effect of growth hormone replacement on inflammatory and other cardiovascular risk factors . DESIGN R and omized , single-blind , placebo-controlled trial . PATIENTS 40 men with adult-onset growth hormone deficiency . INTERVENTION Growth hormone or placebo given for 18 months at a dose adjusted for normal serum insulin-like growth factor I level . MEASUREMENTS Anthropometric , hemoglobin A1c , and central fat values were assessed every 6 months . Levels of glucose , insulin , insulin-like growth factor I , and lipids were measured at 1 , 3 , 6 , 12 , and 18 months . C-reactive protein , serum amyloid polypeptide A , inteleukin-6 , and lipoprotein(a ) levels were determined at baseline and 6 and 18 months . RESULTS C-reactive protein and inteleukin-6 levels decreased in growth hormone recipients compared with placebo recipients ( differences between groups , -1.9 + /- 0.6 mg/L [ P = 0.0027 ] and -1.3 + /- 0.5 ng/L [ P = 0.013 ] , respectively ) . Changes in serum amyloid polypeptide A levels between groups did not reach statistical significance ( difference between groups , -2.4 + /- 1.2 mg/L ; P = 0.056 ) . Serum cholesterol levels , low-density lipoprotein cholesterol levels , and ratios of total cholesterol to high-density lipoprotein cholesterol decreased in growth hormone recipients in the first 3 months compared with placebo recipients ( differences between groups , -0.86 + /- 0.17 mmol/L [ -33.2 + /- 6.6 mg/dL ] [ P < 0.001 ] , -0.63 + /- 0.20 mmol/L [ -24.5 + /- 5.9 mg/dL ] [ P < 0.001 ] , and -0.56 + /- 0.26 [ P = 0.040 ] , respectively ) , but the decrease was not maintained from month 6 to month 18 . Lipoprotein(a ) levels increased ( difference between groups , 22.0 + /- 8.0 mg/L ; P = 0.0096 ) . Short-term increases occurred in glucose levels , insulin levels , and insulin-to-glucose ratios ( differences between groups , 0.54 + /- 0.16 mmol/L [ 9.6 + /- 2.8 mg/dL ] [ P = 0.0018 ] , 37.9 + /- 9.6 pmol/L [ P < 0.001 ] , and 6.0 + /- 1.8 [ P = 0.0025 ] , respectively ) , but only the increase in glucose level was maintained over the long term ( difference between groups , 0.56 + /- 0.17 mmol/L [ 10.0 + /- 3.1 mg/dL ] ; P = 0.0026 ) . Hemoglobin A1c values did not change . Truncal fat-to-total fat ratios decreased ( difference between groups , -0.018 + /- 0.007 ; P = 0.0087 ) . CONCLUSIONS Long-term growth hormone replacement in men reduces levels of inflammatory cardiovascular risk markers , decreases central fat , and increases lipoprotein(a ) and glucose levels without affecting lipid levels
Emerging cardiovascular risk factors/markers such as proinflammatory cytokines , C-reactive protein , and adipokines are also increased in GHD patients .
Increased cardiovascular morbidity and mortality have also been reported in GHD .
GH treatment has been shown to improve both traditional and emerging cardiovascular risk factors and markers .
The GHD population may be considered at high cardiovascular risk , and GH substitution may be expected to bring an added value to patients with hypopituitarism in terms of cardiovascular protection .
CONTEXT GH deficiency ( GHD ) of the adult is a clinical condition characterized by the presence of several traditional and emerging cardiovascular risk factors that can significantly increase cardiovascular morbidity and mortality .
It is still an open issue whether GH replacement is able not only to improve cardiovascular risk factors but also to decrease cardiovascular morbidity and mortality .
EVIDENCE SYNTHESIS In untreated GHD , cardiovascular risk is increased due to abnormal lipid profile ( increased total and low-density lipoprotein cholesterol , increased triglycerides , and reduced high-density lipoprotein cholesterol ) and impaired glucose metabolism .