Growth hormone treatment on atherosclerosis: results of a 5-year open, prospective, controlled study in male patients with severe growth hormone deficiency

Annamaria Colao, Carolina Di Somma, Stefano Spiezia, Silvia Savastano, Francesca Rota, Maria Cristina Savanelli, Gaetano Lombardi
Journal of Clinical Endocrinology and Metabolism 2008, 93 (9): 3416-24

BACKGROUND: Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and intima-media thickness (IMT) at major arteries.

OBJECTIVE: The objective of the study was to investigate the 5-yr effects of GH replacement on common carotid IMT and insulin resistance syndrome (IRS) (at least two of the following: triglycerides levels > or = 1.7 mmol/liter, high-density lipoprotein-cholesterol levels < or = 1.0 mmol/liter, blood pressure above 130/85 mm Hg, fasting glucose 6.1-7 or 2 hr after glucose 7.7-11.1 mmol/liter).

DESIGN: This was an interventional, open, prospective, controlled study.

PATIENTS: Patients included 35 men with severe GHD and 35 age-matched healthy men as controls.

INTERVENTION: All patients received standard replacement therapy; GH replacement was added in 22 patients (group A) and refused by 13 others (group B).

MEASUREMENTS: Five-year changes in IMT and IRS prevalence were measured.

RESULTS: At baseline, IMT was higher in the patients with (P < 0.001) and without IRS (P = 0.004) than in controls. Eighteen patients (51.4%) and two controls (5.7%; P < 0.0001) had IRS. At study end, use of lipid-lowering drugs (92.3, vs. 13.6 and 34.3%, P < 0.0001), glucose-lowering drugs (69.2 vs. 31.4 and 22.7%; P = 0.016), and antihypertensive drugs (61.5 vs. 20.0 and 4.5%; P < 0.0001) was higher in group B patients than controls and group A patients. IGF-I levels normalized in all group A patients and remained lower than -1 sd score in 77% of group B patients. IMT significantly decreased only in group A and significantly increased in controls and nonsignificantly in group B patients. IRS prevalence significantly reduced only in group A patients.

CONCLUSIONS: Severely hypopituitary GHD men have more frequently increased IMT at common carotid arteries and IRS than controls. After 5 years, only in GH replaced patients, IMT and prevalence of IRS decreased.

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