Cardiovascular outcomes and conventional risk factors in nondiabetic adult patients with GH deficiency: a long-term retrospective cohort study

Purpose: To investigate the association between cardiovascular (CV) risk factors and cumulative CV events in patients with growth hormone deficiency (GHD) receiving GH replacement therapy (GHRT). Methods: 53 non-diabetic adult GHD patients, aged 45.4±14.3 years, 31 females, with a median follow up of 140 months, were divided into two groups based on the presence (group-A) or absence (group-B) of systemic hypertension. Tertiles of age and LDL-cholesterol were considered as further potential prognosticators. Cumulative CV event rates were recorded and analyzed with Kaplan-Mayer method. Differences between patients with and without events were also explored. Results: 17 patients (32%) entered the group-A and 36 (68%) the group-B. A composite of fatal and non-fatal CV events occurred in 22.6% of patients, 47.1% in group A and 11% in group B (p=0.01), CV deaths in 3 patients (5.7%; annual death rate 0.49%), 2 of whom were in group A. At Kaplan-Mayer analysis, hypertension and age>55 years were major prognosticators. The odds ratio was 7.1 (95%CI: 1.74–29.12, p<0.003) and 6.2 (95%CI: 1.54– 25.04, p<0.006), respectively. LDL-cholesterol showed borderline statistical significance. Patients with CV events also had high prevalence of left ventricular hypertrophy, left atrial enlargement and subclinical systolic dysfunction. Conclusions: In this study, outcomes were mainly related to hypertension and age (partially to LDL-cholesterol), confirming that management of GHD patients must be inclusive of treatment of conventional risk factors, being as important as GHRT. Optimal blood pressure control is crucial when a target organ damage is present and in patients older than 55 years.