What is the risk for cardiovascular disease in adult growth hormone (GH) deficiency?

Updated: Jun 26, 2018
  • Author: Mohsen S Eledrisi, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Early epidemiologic data showed that patients with hypopituitarism who were on hormone replacement therapy, not including GH, had increased cardiac events, suggesting an association of GH deficiency with cardiovascular disease. [14, 28, 29, 30, 31]  Patients with GH deficiency have increased rates of the presence of markers of cardiovascular disease, such as greater intima-media thickness of the carotid arteries, reduced left ventricular mass, decreased ejection fraction, high levels of serum low-density lipoprotein (LDL) cholesterol (LDL-C) and triglycerides, low levels of high-density lipoprotein (HDL) cholesterol (HDL-C), and high coronary calcium scores. [14, 29, 30, 32]  GH therapy improves certain markers of cardiovascular disease, such as serum lipids (reduction of LDL-C levels and increase in HDL-C levels), systolic function, intima-media thickness of the carotid arteries, endothelial function, left ventricular mass, and cardiac output. [29, 33, 34, 35]  However, evidence is limited regarding the effect of GH replacement therapy on cardiovascular morbidity and mortality. [28, 29, 36]

A study that evaluated the prevalence of metabolic syndrome and associated cardiovascular complications in adult-onset GH deficiency during GH replacement therapy found an essentially unchanged prevalence of metabolic syndrome in these patients during 1 year of GH therapy. [37]  However, there was a significant reduction in abnormal waist circumference (P<0.001), a significant increase in impaired glucose metabolism (P <0.001), and a decrease in HDL-C (P = 0.011). Moreover, over a 7-year period of GH therapy, those with metabolic syndrome had a 66% higher risk of developing a new coronary disease compared to those without metabolic syndrome (P = 0.0016). [37]

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