Cardiovascular risk in adult patients with growth hormone (GH) deficiency and following substitution with GH--an update.
BACKGROUND
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.


METHODS
The major source of data acquisition included PubMed research strategies. Original articles, systematic reviews and meta-analyses, and included relevant citations were screened.


RESULTS
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. 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. However, evidence on the effects of GH replacement on cardiovascular events and mortality is limited.


CONCLUSIONS
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. However, there is too limited evidence (rarely coming from randomized and controlled studies) to recommend GH treatment based on the cardiovascular status of the patients.
Chair of Endocrinology (I.K., A.G.) and Nuclear Medicine (R.G.), University of Brescia, 25123 Brescia, Italy; Department of Internal Medicine (C.G.), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, 20097 San Donato Milanese, Italy; and Department of Internal Medicine (M.G.), Mirandola Hospital, 41037 Modena, Italy.
Carmine
C
Gazzaruso
Monica
M
Gola
Ioannis
I
Karamouzis
Raffaele
R
Giubbini
Andrea
A
Giustina
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005947:Glucose / Q000378:metabolism; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D007333:Insulin Resistance / Q000502:physiology; D012307:Risk Factors
D019382:Human Growth Hormone; D005947:Glucose