title: Nonfatal stroke, cardiac disease, and diabetes mellitus in hypopituitary patients on hormone replacement including growth hormone.
abstract: BACKGROUND
  The impact of long-term GH replacement on cerebrovascular and cardiovascular diseases and diabetes mellitus in hypopituitary patients is unknown.
  
  
  OBJECTIVE
  The incidence of nonfatal stroke and cardiac events, and prevalence of type 2 diabetes mellitus (T2D) and cardioprotective medication were compared between cohorts of GH-deficient (GHD) patients and population controls.
  
  
  METHODS
  The incidence of nonfatal stroke and cardiac events was estimated retrospectively from questionnaires in 750 GHD patients and 2314 matched population controls. A prevalence of T2D and cardioprotective medication was recorded at the distribution of questionnaires. Time since first pituitary deficiency to start of GH therapy was 4 and 2 yr, and time on GH therapy was 6 yr for GHD women and men, respectively.
  
  
  RESULTS
  Lifelong incidence of nonfatal stroke was tripled in GHD women and doubled in GHD men, but a decline was seen in both genders during periods after first pituitary hormone deficiency and GHD, during which most patients had GH therapy. The lifelong incidence of nonfatal cardiac events declined in GHD men during first pituitary hormone deficiency and GHD periods. GHD women had a higher prevalence of T2D and lipid-lowering medication, whereas GHD men had a higher prevalence of antihypertensive medication.
  
  
  CONCLUSIONS
  The declined risks of nonfatal stroke in both genders and of nonfatal cardiac events in GHD men during periods on GH replacement may be caused by prescription of cardioprotective drugs and 6-yr GH replacement. GHD women had an increased prevalence of T2D, partly attributed to higher body mass index and lower physical activity.
authors.affiliation: Department of Internal Medicine, Centralsjukhuset, SE-291 85, Kristianstad, Sweden.
authors.forename: Helene
authors.initials: H
authors.lastname: Holmer
authors.forename: Johan
authors.initials: J
authors.lastname: Svensson
authors.forename: Lars
authors.initials: L
authors.lastname: Rylander
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
authors.forename: Thord
authors.initials: T
authors.lastname: Rosén
authors.forename: Bengt-Ake
authors.initials: BA
authors.lastname: Bengtsson
authors.forename: Marja
authors.initials: M
authors.lastname: Thorén
authors.forename: Charlotte
authors.initials: C
authors.lastname: Höybye
authors.forename: Marie
authors.initials: M
authors.lastname: Degerblad
authors.forename: Margareta
authors.initials: M
authors.lastname: Bramnert
authors.forename: Erik
authors.initials: E
authors.lastname: Hägg
authors.forename: Britt
authors.initials: B
authors.lastname: Edén Engström
authors.forename: Bertil
authors.initials: B
authors.lastname: Ekman
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Lars
authors.initials: L
authors.lastname: Hagmar
authors.forename: Eva-Marie
authors.initials: EM
authors.lastname: Erfurth
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D019382:Human Growth Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000453:epidemiology*
chemical_list: D002316:Cardiotonic Agents; D019382:Human Growth Hormone