title: Effects of growth hormone replacement within the KIMS survey on estimated cardiovascular risk and predictors of risk reduction in patients with growth hormone deficiency.
abstract: OBJECTIVE
  There is growing evidence for an increased cardiovascular (CV) risk in untreated growth hormone deficiency of adults (GHD). We aimed at estimating CV risk with established algorithms before and during GH replacement in GHD and in healthy controls and at identifying predictors of risk reduction.
  
  
  METHODS
  A prospective, nested case-control study.
  
  
  METHODS
  We included 344 patients (44·7 ± 14·9 years) from the German Pfizer (formerly Kabi) International Metabolic Database (KIMS) cohort and included a healthy sex- and age-matched control group from a primary care cohort.
  
  
  METHODS
  We calculated Framingham, Prospective Cardiovascular Münster Heart Study (PROCAM) and European Society of Cardiology (ESC) Score algorithms at all time points. In multivariate analyses, we analysed potential predictors of 2-year reduction in CV risk, defined as a higher than median reduction in risk.
  
  
  RESULTS
  In KIMS, the estimated 10-year risks of CV events or CV mortality calculated with Framingham, PROCAM and ESC Score algorithms at baseline were 4·6%, 6·0% and 2·3%, respectively. These dropped to 2·4%, 4·8% and 0·8%, respectively, after 2 years of GH replacement (all P < 0·001 vs baseline) and returned to baseline levels after four years of GH replacement. In controls, the Framingham risk estimates were lower than in KIMS at baseline. All risk estimates increased during follow-up and were significantly higher than in KIMS after four years (all P < 0·01). In backward-selection models, high total cholesterol, low high-density lipoprotein (HDL) cholesterol and male sex were significant predictors of response in most scores.
  
  
  CONCLUSIONS
  Two years of GH replacement decreased CV risk estimates approximately by half. Male sex, high total and low HDL cholesterol levels are potential predictors of good response.
authors.affiliation: Medizinische Klinik - Innenstadt, Ludwig-Maximilians University, Munich, Germany. harald.schneider@med.uni-muenchen.de
authors.forename: Harald Jörn
authors.initials: HJ
authors.lastname: Schneider
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Günter Karl
authors.initials: GK
authors.lastname: Stalla
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.forename: Peter Herbert
authors.initials: PH
authors.lastname: Kann
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany / Q000453:epidemiology; D006130:Growth Disorders / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology*; D006306:Health Surveys; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D019382:Human Growth Hormone