title: Fasting levels of high-sensitivity growth hormone predict cardiovascular morbidity and mortality: the Malmö Diet and Cancer study.
abstract: BACKGROUND
  Both pathological excess and deficiency of growth hormone (GH) are associated with cardiovascular mortality.
  
  
  OBJECTIVE
  The goal of this study was to test whether fasting levels of growth hormone measured with a high-sensitivity assay (hs-GH) predict cardiovascular morbidity and mortality at the population level.
  
  
  METHODS
  We studied 4,323 participants (age 46 to 68 years; mean age 58 years; 59% women) of the Swedish, population-based Malmö Diet and Cancer study examined in 1991 to 1994. Using multivariate-adjusted Cox proportional hazards models, we related baseline levels of fasting hs-GH to incidence of coronary artery disease, stroke, congestive heart failure, all-cause mortality, and cardiovascular mortality.
  
  
  RESULTS
  During a median follow-up of 16.2 years, hs-GH (hazard ratio [HR]/SD increment of natural logarithm of fasting hs-GH) was independently associated with increased risk of coronary artery disease (397 events; HR: 1.11; 95% confidence interval [CI]: 1.01 to 1.23; p = 0.04), stroke (251 events; HR: 1.18; 95% CI: 1.04 to 1.34; p = 0.01), congestive heart failure (107 events; HR: 1.25; 95% CI: 1.03 to 1.52; p = 0.02), all-cause mortality (645 events; HR: 1.17; 95% CI: 1.08 to 1.26; p < 0.001) and cardiovascular mortality (186 events; HR: 1.43; 95% CI: 1.24 to 1.66; p < 0.001). The addition of hs-GH to a model with conventional cardiovascular risk factors significantly reclassified risk, with a category-free net reclassification improvement (>0) of 0.542 (95% CI: 0.205 to 0.840) in cardiovascular mortality.
  
  
  CONCLUSIONS
  Higher values of hs-GH were associated with an increased risk of cardiovascular morbidity and mortality.
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Hallengren
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Almgren
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Persson
authors.affiliation: ICI Immunochemical Intelligence GmbH, Berlin, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Suhr
authors.affiliation: SphingoTec GmbH, Hohen Neuendorf, Germany; Waltraut Bergmann Foundation, Hohen Neuendorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden. Electronic address: olle.melander@med.lu.se.
authors.forename: Olle
authors.initials: O
authors.lastname: Melander
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology; D004032:Diet; D005215:Fasting; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000097:blood* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone
keywords: cardiovascular disease; epidemiology; growth hormone; mortality