Improved Cardiovascular Risk Factors and Cardiac Performance after 12 Months of Growth Hormone (GH) Replacement in Young Adult Patients with GH Deficiency1
Annamaria Colao,
Carolina di Somma,
Alberto Cuocolo,
Letizia Spinelli,
Nicolina Tedesco,
Rosario Pivonello,
Domenico Bonaduce,
Marco Salvatore and
Gaetano Lombardi
Departments of Molecular and Clinical Endocrinology and Oncology,
Nuclear Medicine Center of the National Council of Research
(A.Co., C.D.S., R.P., G.L.); Departments of Biomorphological and
Functional Sciences (A.Cu., N.T., M.S.) and Internal Medicine I (L.S.,
D.B.), Federico II University of Naples, 80131 Naples; and Scientific
Institute for Research and Cure Neuromed (A.Cu.), Pozzilli,
Italy
Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it
Adult GH deficiency (GHD) is associated with increased cardiovascular
morbidityand mortality due to unfavorable lipid profile,
hyperfibrinogenemia,and impairment of cardiac performance. This
prospective controlledcohort study evaluated the effects of 12-month
GH replacementon lipid profile, fibrinogen levels, cardiac mass by
echocardiography,and performance by equilibrium radionuclide
angiography. Tothis end we studied 20 patients (11 men and 9 women,
aged 19–40yr), 10 with childhood-onset (co-) and 10 with adult-onset
(ao-)disease, and 20 sex- and age-matched healthy subjects. At study
entry,insulin-like growth factor I (IGF-I; P <
0.0001) and highdensity lipoprotein (HDL) cholesterol
(P < 0.0001) levels,left ventricular mass index
(LVMi; P < 0.0001), ejectionfraction (LVEF) at
rest (P = 0.001) and at peak exercise
(P< 0.0001), peak ejection rate
(P = 0.005), and exercise duration
(P< 0.0001) and capacity (P =
0.002) were lower, whereas totalcholesterol (P =
0.02), triglycerides (P = 0.003), and fibrinogen
(P= 0.005) levels were higher in patients than in
controls. After12 months, increases in IGF-I (P <
0.0001) and HDL cholesterollevels (P = 0.04), LVMi
(P < 0.0001), LVEF at peak exercise
(P< 0.0001), and exercise duration
(P = 0.009) and capacity(P =
0.003) and decreases in total cholesterol (P <
0.0001),low density lipoprotein cholesterol (P <
0.0001), triglycerides(P < 0.0001), and
fibrinogen (P = 0.01) levels were foundin all
patients, without any difference between co- and ao-GHD.At the end of
treatment, however, total cholesterol, triglycerides,and fibrinogen
levels were still higher, and HDL cholesterollevels, IGF-I levels, and
LVEF at rest and at peak exercisewere lower in patients than in
controls.
In conclusion, GH replacement for 12 months significantly improved
lipidprofile, decreased fibrinogen levels, and increased LVMi andLVEF
in young adults with co- or ao-GHD. However, lipid profile,fibrinogen
levels, and systolic function remained abnormal comparedwith those in
age- and sex-matched controls, suggesting thata longer period of GH
replacement is necessary to normalizecardiovascular parameters and
reverse the cardiovascular riskof these patients.
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