From: Doug Skrecky (oberon@vcn.bc.ca)
Date: Mon Sep 06 1999 - 02:15:39 MDT
Citations: 1-2
<1>
Authors
Borson-Chazot F. Serusclat A. Kalfallah Y. Ducottet X. Sassolas G.
Bernard S. Labrousse F. Pastene J. Sassolas A. Roux Y. Berthezene F.
Institution
Service d'Endocrinologie, Hopital de l'Antiquaille, Lyon, France.
Title
Decrease in carotid intima-media thickness after one year
growth hormone (GH) treatment in adults
with GH deficiency.
Source
Journal of Clinical Endocrinology & Metabolism. 84(4):1329-33, 1999 Apr.
Abstract
An increased carotid arterial intima-media thickness (IMT) has been reported
in hypopituitary adults untreated for GH deficiency. In the present study,
the effect of GH replacement on IMT and cardiovascular risk factors was
prospectively investigated, in GH deficiency patients treated at a mean dose
of 1 UI/day during 1 yr (n = 22) and 2 yr (n = 11). The IMT measurements were
performed by the same experienced physician, and the coefficient of variation
(calculated in two control groups) was below 6.5%. IMT at baseline was
related to conventional risk factors. After 1 yr GH treatment, IMT decreased
from 0.78 +/- 0.03 mm to 0.70 +/- 0.03 mm (P < 0.001). The decrement was
observed in 21 of 22 patients. After 2 yr GH treatment, IMT had stabilized at
0.70 +/- 0.04 mm and remained significantly different from baseline values (P
< 0.003). GH treatment resulted in a moderate decrease in waist circumference
and body fat mass and an increase in VO2 max. Conventional cardiovascular
risk factors were unmodified except for a transient 10% decrease in
low-density lipoprotein cholesterol at 6 months. The contrast between the
limited metabolic effect of treatment and the importance and precocity of the
changes in IMT suggests that the decrease in IMT was not exclusively
attributable to a reversal in the atherosclerotic process. A direct parietal
effect of GH replacement on the arterial wall might also be involved. The
consequences, in terms of cardiovascular risk, should be established by
randomized prospective trials.
<2>
Authors
Pfeifer M. Verhovec R. Zizek B. Prezelj J. Poredos P. Clayton RN.
Institution
Department of Endocrinology, Diabetes and Metabolic Diseases, University
Medical Center, Ljubljana, Slovenia.
Title
Growth hormone (GH) treatment reverses
early atherosclerotic changes in GH-deficient adults.
Source
Journal of Clinical Endocrinology & Metabolism. 84(2):453-7, 1999 Feb.
Abstract
Hypopituitary patients have increased mortality from vascular disease, and in
these patients, early markers of atherosclerosis [increased carotid artery
intima-media thickness (IMT) and reduced distensibility] are more prevalent.
As GH replacement can reverse some risk factors of atherosclerosis, the
present study examined the effect of GH treatment on morphological and
functional changes in the carotid and brachial arteries of GH-deficient (GHD)
adults. Eleven GHD hypopituitary men (24-49 yr old) were treated with
recombinant human GH (0.018 U/kg BW x day) for 18 months. IMT of the common
carotid artery (CCA) and the carotid bifurcation (CB), and flow-mediated
endothelium-dependent dilation (EDD) of the brachial artery were measured by
B mode ultrasound before and at 3, 6, 12, and 18 months of treatment, and
values were compared with those in 12 age-matched control men. Serum
concentrations of lipids, lipoprotein(a), insulin-like
growth factor I (IGF-I), and IGF-binding protein-3 (IGFBP-3)
were also measured. In GHD men before treatment the IMTs of the CCA
[mean(SD), 0.67(0.05) mm] and CB [0.75(0.04) mm] were significantly greater
(P < 0.001) than those in control men [0.52(0.07) and 0.65(0.07) mm,
respectively]. GH treatment normalized the IMT of the CCA by 6 months
[0.53(0.04) mm] and that of the CB by 3 months [0.68(0.05) mm]. The IMT of
the carotid artery (CCA and CB) was negatively correlated with serum IGF-I (r
= -0.53; P < 0.0001). There was a significant improvement in flow-mediated
EDD of the brachial artery at 3 months, which was sustained at 6 and 18
months of GH treatment (P < 0.05). GH treatment increased high density
lipoprotein cholesterol at 3 and 6 months, but did not reduce total or low
density lipoprotein cholesterol and was without effect on lipoprotein(a).
There was no correlation between plasma lipids and changes in IMT or EDD of
the arteries examined. In conclusion, GH treatment of hypopituitary GHD men
reverses early morphological and functional atherosclerotic changes in major
arteries and, if maintained, may reduce vascular morbidity and mortality. GH
seems to act via IGF-I, which is known to have important effects on
endothelial cell function.
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