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Cardiovascular outcomes and conventional risk factors in non-diabetic adult patients with GH deficiency: A long-term retrospective cohort study

Published:November 05, 2015DOI:https://doi.org/10.1016/j.ejim.2015.10.017

      Highlights

      • Increased cardiovascular (CV) risk has been reported in patients with GH deficiency.
      • The role for conventional CV risk factors has not been well established.
      • We investigated the association among the main CV risk factors and outcomes.
      • We confirm this association being as important as in the general population.
      • Treatment of GHD patients should be inclusive of CV risk factors.

      Abstract

      Purpose

      To investigate the association between cardiovascular (CV) risk factors and cumulative CV events in patients with growth hormone deficiency (GHD) receiving GH replacement therapy (GHRT).

      Methods

      53 non-diabetic adult GHD patients, aged 45.4 ± 14.3 years, 31 females, with a median follow up of 140 months, were divided into two groups based on the presence (group A) or absence (group B) of systemic hypertension. Tertiles of age and LDL-cholesterol were considered as further potential prognosticators. Cumulative CV event rates were recorded and analyzed by Kaplan–Mayer method. Differences between patients with and without events were also evaluated.

      Results

      Seventeen patients (32%) entered the group A and 36 (68%) the group B. A composite of fatal and non-fatal CV events occurred in 22.6% of patients, 47.1% in group A and 11% in group B (p = 0.01), CV deaths in 3 patients (5.7%; annual death rate 0.49%), 2 of whom were in group A. At Kaplan–Mayer analysis, hypertension and age > 55 years were major prognosticators. The odds ratio was 7.1 (95% CI: 1.74–29.12, p < 0.003) and 6.2 (95% CI: 1.54–25.04, p < 0.006), respectively. LDL-cholesterol showed borderline statistical significance. Patients with CV events also had high prevalence of left ventricular hypertrophy, left atrial enlargement and subclinical systolic dysfunction.

      Conclusions

      In this study, outcomes were mainly related to hypertension and age (partially to LDL-cholesterol), confirming that management of GHD patients must be inclusive of treatment of conventional risk factors, being as important as GHRT. Optimal blood pressure control is crucial when a target organ damage is present and in patients older than 55 years.

      Keywords

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