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 treatment on arginine to asymmetric dimethylarginine ratio and endothelial function in patients with growth hormone deficiency.
Patients with growth hormone deficiency ( GHD ) are known to have reduced life expectancy due to increased cardiovascular and cerebrovascular events . An increase in asymmetric dimethylarginine ( ADMA ) levels previously found in GHD patients could promote premature atherosclerosis . The aim of this study was to determine whether 6-month growth hormone ( GH ) replacement therapy was able to decrease ADMA levels and ameliorate endothelial dysfunction .  Thirty-one GHD patients were studied before and after 6 months of GH ( 4 microg/[kg d ] , daily ) replacement therapy . Reduced pretreatment levels of serum insulin-like growth factor ( IGF ) 1 were normalized during GH treatment ( 88.2 + /- 62.5 to 191.7 + /- 80.3 ng/mL , P < .0001 ) . After 6 months of GH replacement , plasma cyclic guanosine monophosphate levels significantly increased ( 2.14 + /- 0.52 to 3.54 + /- 1.2 ng/mL , P < .0001 ) , serum ADMA levels were significantly decreased ( 0.65 + /- 0.1 vs 0.59 + /- 0.11 mumol/L , P < .05 ) , and arganine ( Arg ) to ADMA ratio was significantly higher ( 155 + /- 53 vs 193 + /- 61 , P < .01 ) . No changes were observed for plasma nitric oxide end products ( nitrite and nitrate ) levels after GH treatment ( 21.9 + /- 14.9 vs 24.1 + /- 19.0 mumol/L , not significant ) . Basal forearm blood flow remained unchanged , whereas reactive hyperemia increased from 7.30 + /- 5.31 mL/100 mL forearm per minute before GH therapy to 13.18 + /- 7.30 mL/100 mL forearm per minute after 6 months of therapy ( P < .001 ) . There was a positive correlation between IGF-1 and cyclic guanosine monophosphate ( r = 0.73 , P < .0001 ) , IGF-1 and reactive hyperemia ( r = 0.63 , P < .0001 ) , and IGF-1 and Arg/ADMA ratio ( r = 0.44 , P < .01 ) . Conversely , a negative correlation was found between IGF-1 and ADMA levels ( r = -0.41 , P < .02 ) . At the end of the study period , fat-free mass , plasma glucose , and hemoglobin A(1c ) levels significantly increased , even if they were still in the reference range , suggesting moderate alteration of glucose metabolism . In conclusion , in GHD patients , GH replacement contributes to decreased , to some extent , cardiovascular risk , reducing ADMA levels and improving Arg/ADMA ratio and endothelial dysfunction
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 .