The prevelance of metabolic syndrome (MetS) in patients with adult growth hormone deficiency (AGHD) is between 1.3- and 2-fold greater than found in the general population. Growth hormone supplementation in these patients is known to improve the components of MetS but no study to date has found a decrease in the prevalence of MetS during GH replacement therapy. Verhelst et al set out to investigate this, looking at the impact of one year of GH therapy on prevalence of the syndrome and its components and also assessing the incidence of cardiovascular and cerebrovascular morbidity during long-term GH replacement.
Find highlights of the study and take home points for clinical practice in the short slide show above.
GHD and Metabolic Syndrome. Patients with adult growth hormone deficiency (AGHD) are known to be at increased risk for MetS, comprised of 5 CV risk factors: Increased waist circumference due to visceral fat accumulation, elevated blood pressure, low HDL cholesterol, elevated triglycerides, and impaired glucose tolerance.
The Study. A total 1449 patients met inclusion criteria for the MetS prevalance analysis; 51% women, mean age ~48 years; mean age of men 50 years. Diagnosis of MetS was determined using International Diabetes Federation criteria.
Results. After 1 year of GH replacement therapy, there was a nonsignificant increase in rate of MetS of 3% in the prevalence analysis group, essentially indicating no change in prevalence. GH replacement did improve all components of MetS except glucose intolerance. There was a 66% higher risk of new CV events during chronic GH replacement therapy in patients with MetS vs no MetS.
Take Home Points
It appears prevalence of MetS in those with AGHD is not reduced with GH treatment, however there are confounding factors to consider, ie, use at baseline of antihypertensive, lipid-lowering, antidiabetic meds, most likely not d/c’d during GH replacement.
Patients without MetS respond more favorably to GH therapy
Positive changes in all five components of MetS
Prolonged GH replacement alone is not sufficient to ameliorate enhanced CV risk associated with long-term disease