Cardiac Effects of Growth Hormone in Adults With Growth Hormone Deficiency

Abstract

Background-Growth hormone (GH) treatment may improve morphological and functional cardiac parameters in adults with GH deficiency (GHD). However, clinical trials reported to date involved few patients and yielded variable effects. Methods and Results-We systematically reviewed blinded, placebo-controlled, randomized clinical trials of GH treatment in adults with GHD and open studies in patients with GHD before and after GH treatment, evaluating the effects of GH on cardiac parameters assessed by echocardiography. Sixteen trials (9 blinded and 7 open), involving a total of 468 patients, were identified in 3 bibliographic databases. GH dosage, duration of treatment, and study populations varied among the studies. We conducted a combined analysis of effects on left ventricular mass (LVM), interventricular septum thickness (IVS), left ventricular posterior wall (LVPW), left ventricular end-systolic (LVESD) and diastolic (LVEDD) diameters, stroke volume, E/A ratio, isovolumic relaxation time (IRT), and fractional shortening. Overall effect size was used to evaluate significance, and weighted mean difference between GH and control was given to appreciate size of the effect. GH treatment was associated with a significant increase in LVM: ϩ10.

Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]

“…In 2003 a meta-analysis reviewed sixteen trials (9 blinded and 7 open) considering 468 patients who belonged to different populations and who were being treated with different GH dosages and duration of therapy; significant positive effects of GH on cardiac parameters assessed by echocardiography were evident. In particular, LV mass increased by 10.8 (standard deviation: 9.3) g (P=0.02); similarly interventricular septum thickness increased by 0.28 mm (P<0.001) and LV posterior wall by 0.98 mm (P=0.05), confirming the effectiveness of GH replacement therapy on cardiac morphology [77]. Also, Giustina et al demonstrated that GH has acute functional effects on the heart in patients with congestive heart failure (CHF), including both an increase in myocardial contractility and a decrease in vascular resistances, and among patients with CHF, those with low baseline IGF-1 are likely to have fewer beneficial effects from GH infusion [78].…”

Arrest of atherosclerosis progression after interruption of GH replacement in adults with congenital isolated GH deficiency

“…The reported effects of GH replacement on cardiac performance are conflicting (24,25). A meta-analysis reported an increase in myocardial mass and improvement in systolic and diastolic functions, increase in LV mass, septal thickness, left ventricular posterior wall thickness, and end diastolic volume caused by GHRT in AOGHD (25).…”

“…A meta-analysis reported an increase in myocardial mass and improvement in systolic and diastolic functions, increase in LV mass, septal thickness, left ventricular posterior wall thickness, and end diastolic volume caused by GHRT in AOGHD (25). On the other hand, no significant changes have been reported in fractional shortening, left ventricular end systolic diameter, and E/A ratio (25).…”

“…A meta-analysis reported an increase in myocardial mass and improvement in systolic and diastolic functions, increase in LV mass, septal thickness, left ventricular posterior wall thickness, and end diastolic volume caused by GHRT in AOGHD (25). On the other hand, no significant changes have been reported in fractional shortening, left ventricular end systolic diameter, and E/A ratio (25). Our study shows that the increase in all the LV mass parameters caused by GHRT persisted at 60mo, suggesting permanent structural changes and showing that even a relatively short-term GHRT may change cardiac anatomy well beyond the end of therapy.…”

Low-Dose Growth Hormone is Cardioprotective in Uremia

“…13,14 These manifestations of GH deficiency or excess can be reversed with correction of the abnormal GH state. [17][18][19] Interestingly, there is evidence that GH may have a favorable effect on cardiac remodeling and cardiac output in pituitary intact animals and possibly humans with cardiac disease. 14,20,21 In advanced CRF, resistance to GH develops, and this is a cause of growth retardation in children and muscle wasting in adults.…”