scholarly journals Sustained effects of recombinant GH replacement after 7 years of treatment in adults with GH deficiency

2006 ◽  
Vol 155 (5) ◽  
pp. 701-708 ◽  
Author(s):  
A A van der Klaauw ◽  
J A Romijn ◽  
N R Biermasz ◽  
J W A Smit ◽  
J van Doorn ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gh Deficiency ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Short Term ◽  
Anthropometric Parameters ◽  
Beneficial Effects ◽  
Gh Replacement

Context: The goal of GH replacement with recombinant human GH (rhGH) is to ameliorate symptoms, signs, and complications of adult GH deficiency (GHD) in the long term. To determine whether the observed short-term beneficial effects of rhGH treatment are sustained in the long term, we evaluated biochemical and anthropometric parameters after 7 years of rhGH replacement. Patients and methods: After 2, 5, and 7 years of rhGH replacement, 63 adult GHD patients (30 men, 52 adult-onset GHD) were assessed. IGF-I increased during rhGH replacement, and a stable dose of rhGH was reached within 1 year of rhGH substitution. Thereafter, this individualized dose was continued. Results: Plasma levels of total cholesterol and low-density lipoprotein cholesterol decreased even after 5 years of rhGH replacement (11% decrease, P < 0.001; 22% decrease, P < 0.001 respectively). High-density lipoprotein cholesterol levels increased during 7 years of rhGH replacement (1.4 ± 0.5 mmol/l at baseline vs 1.7 ± 0.5 mmol/l after 7 years, P < 0.001), whereas triglyceride concentrations remained unchanged. Fasting glucose levels increased during follow-up, mainly during the first 2 years of rhGH replacement (4.4 ± 0.7 mmol/l to 5.0 ± 1.0 mmol/l, P < 0.001). Body mass index increased during follow-up, whereas waist circumference and waist-to-hip ratio remained unchanged. Diastolic blood pressure decreased (P = 0.002), but when patients using antihypertensive medication were excluded this decrease did not reach significance (P = 0.064). Systolic blood pressure remained unchanged. Conclusion: The beneficial effects of rhGH replacement, described after short-term rhGH replacement, are sustained in the long term up to 7 years.

scholarly journals Effect of long-term GH replacement therapy on cardiovascular outcomes in isolated GH deficiency compared with multiple pituitary hormone deficiencies: a sub-analysis from the Dutch National Registry of Growth Hormone Treatment in Adults

2014 ◽  
Vol 171 (2) ◽  
pp. 151-160 ◽  
Author(s):  
Christa C van Bunderen ◽  
Carline J van den Dries ◽  
Martijn W Heymans ◽  
Anton A M Franken ◽  
Hans P F Koppeschaar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Replacement Therapy ◽  
Clinical Presentation ◽  
Gh Deficiency ◽  
National Registry ◽  
Pituitary Hormone ◽  
Gh Treatment ◽  
Gh Replacement

ObjectiveIsolated GH deficiency (IGHD) could provide a model to investigate the influence of GH deficiency per se and the effect of GH replacement therapy without the influence from other pituitary hormone deficiencies or their treatment. The aim of this study is to address the questions about differences between IGHD and multiple pituitary hormone deficiencies (MPHDs) in clinical presentation and in responsiveness to GH treatment.DesignA nationwide surveillance study was carried out to describe the difference in the clinical presentation and responsiveness to GH treatment of patients with IGHD and MPHDs.MethodsThe Dutch National Registry of GH Treatment in Adults was founded in 1998 to gain more insight into long-term efficacy and safety of GH therapy. Out of 2891 enrolled patients, 266 patients with IGHD at the start of GH treatment were identified and compared with 310 patients with MPHDs. Cardiovascular indices will be investigated at baseline and during long-term follow-up, including body composition, lipid profile, glucose metabolism, blood pressure, and morbidity.ResultsPatients with IGHD and MPHDs were demonstrated to be different entities at clinical presentation. Metabolically, patients with MPHDs had a larger waist circumference, lower HDL cholesterol level, and higher triglyceride level. The effect of GH treatment was comparable between patient groups. GH seems to protect against rising lipid levels and blood pressure, even after excluding patients using corresponding concomitant medication. The risk for cardiovascular disease or diabetes mellitus during follow-up was not different between patients with IGHD and MPHDs.ConclusionsPatients with IGHD had a less impaired metabolic profile than patients with MPHDs at baseline. Influence of other pituitary hormone replacement therapies on the effect of GH treatment is not demonstrated.

scholarly journals Does long-term GH replacement therapy in hypopituitary adults with GH deficiency normalise quality of life?

2006 ◽  
Vol 155 (1) ◽  
pp. 109-119 ◽  
Author(s):  
Maria Koltowska-Häggström ◽  
Anders F Mattsson ◽  
John P Monson ◽  
Paul Kind ◽  
Xavier Badia ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gh Deficiency ◽  
Disease Onset ◽  
Life Assessment ◽  
Hormone Deficiency ◽  
Gh Replacement ◽  
Country Specific

Objective: To determine whether impaired quality of life (QoL) in adults with GH deficiency (GHD) is reversible with long-term GH therapy and whether the responses in QoL dimensions differ from each other. Methods: QoL was measured by the Quality of Life–Assessment for Growth Hormone Deficiency in Adults (QoL-AGHDA) in general population samples in England & Wales, The Netherlands, Spain and Sweden (n = 892, 1038, 868 and 1682 respectively) and compared with corresponding patients’ data from KIMS (Pfizer International Metabolic Database) (n = 758, 247, 197 and 484 respectively) for 4–6 years a follow-up. The subsets of patients from England and Wales, and Sweden with longitudinal data for 5 years’ follow-up were also analysed. The change of the total QoL-AGHDA scores and responses within dimensions were evaluated. Subanalyses were performed to identify any specificity in response pattern for gender, age, disease-onset and aetiology. Results: Irrespective of the degree of impairment, overall QoL improved dramatically in the first 12 months, with steady progress thereafter towards the country-specific population mean. Problems with memory and tiredness were the most serious burden for untreated patients, followed by tenseness, self-confidence and problems with socialising. With treatment, these improved in the reverse order, normalising for the latter three. Conclusions: Long-term GH replacement results in sustained improvements towards the normative country-specific values in overall QoL and in most impaired dimensions. The lasting improvement and almost identical pattern of response in each patient subgroup and independent of the level of QoL impairment support the hypothesis that GHD may cause these patients’ psychological problems.

The Effect of Smoking on the Association between Long-Term Alcohol Consumption and Dyslipidemia in a Middle-Aged and Older Population

2020 ◽  
Vol 55 (5) ◽  
pp. 531-539
Author(s):  
Kyueun Lee ◽  
Jihye Kim
Keyword(s):  
Alcohol Consumption ◽  
Smoking Status ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density Lipoprotein Cholesterol ◽  
Current Smoking ◽  
Low Hdl

Abstract Aims The joint effects of chronic alcohol consumption and smoking on dyslipidemia remain unclear in a prospective design. This study examined the effect of smoking on the association between long-term alcohol consumption and risk of incident dyslipidemia. Methods A total of 4467 participants (1866 men and 2601women) aged 40–69 years without dyslipidemia were recruited at baseline. Alcohol consumption was assessed biennially using a questionnaire and classified as light, moderate or heavy drinker. Smoking status was examined at baseline and categorized into non-smokers and current smokers. Dyslipidemia was defined as the presence of one or more of following: hypertriglyceridemia (triglyceride ≥200 mg/dL), hypercholesterolemia (total cholesterol ≥240 mg/dL), low high-density lipoprotein-cholesterol (HDL-C) &lt; 40 mg/dL, or high low-density lipoprotein cholesterol ≥160 mg/dL. Results During a follow-up period of 12 years, 2872 (64.3%) participants developed dyslipidemia. In non-smoking men, light or moderate alcohol consumption was associated with a lower risk of incident dyslipidemia such as hypertriglyceridemia and hypercholesterolemia, whereas this association was not observed in current smoking men. Unlike non-smokers, the duration of alcohol drinking &gt; 10 years was associated with a higher risk of hypertriglyceridemia in current smoking men (hazard ratio = 1.57, 95% confidence interval: 1.07–2.30, P = 0.020). In addition, alcohol consumption was inversely associated with low HDL-C regardless of smoking status. In women, alcohol consumption was inversely associated with dyslipidemia hypercholesterolemia and low HDL-C regardless of alcohol amount. Conclusion Smoking crucially confounds the association between long-term alcohol consumption and dyslipidemia, particularly in hypertriglyceridemia and hypercholesterolemia.

scholarly journals Very low high-density lipoprotein-cholesterol and long-term mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Dykun ◽  
S Hendricks ◽  
O Babinets ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
All Cause Mortality ◽  
Long Term Mortality

Abstract Background High-density lipoprotein-cholesterol (HDL-C) has anti-atherogenic, anti-inflammatory, anti-oxidative, anti-apoptotic, and vasodilatory properties. While a linear inverse relationship between HDL-C levels and all-cause mortality is established, recent observational studies suggest a U-shaped association between HDL-C and outcome. Purpose We tested the hypothesis that both low and high HDL-C levels associate with long-term mortality. Methods The present analysis is based on the longitudinal ECAD registry of consecutive patients undergoing coronary angiography at the West German Heart and Vascular Center between 2004 and 2019. HDL-C was quantified at hospital admission using standardized enzymatic methods. The incidence of death due to any cause was evaluated during follow-up. Cox regression analysis was used to determine the association of HDL-C with incident mortality, adjusting for age, sex, systolic blood pressure, low-density lipoprotein cholesterol, smoking status, and family history of premature cardiovascular disease. In addition to the analysis on HDL-C as continuous variable, the association of HDL-groups (&lt;10th percentile, 10th-&lt;25th percentile, 25th-&lt;50th percentile, 50th-&lt;75th percentile, 75th-90th percentile, and ≥90thpercentile) with incident mortality was determined using HDL-C &lt;10th percentile as reference. Results Among 17,433 patients, mean age was 65.9±12.6 years and 70.1% were men. Mean HDL-C was 48.7±16.2 mg/dL. During a mean follow-up 3.38±2.10 years, 2,401 patients (13.8%) died. In multivariable analysis, higher HDL-C levels were independently associated with lower all-cause mortality [hazard ratio (95% confidence interval): 0.83 (0.76, 0.91) per 1 standard deviation change in HDL-C, p&lt;0.001]. Associations between HDL-C and mortality were equally present in male [0.83 (0,74, 0.93), p=0.001] and female patients [0.85 (0.73, 1.00), p=0.0496]. Using HDL-C &lt;10thpercentile as reference (&lt;31mg/dl), all other HDL-C groups showed stable effect sizes below 1.0 without signs of increasing morality probability in high HDL-C groups [0.50 (0.44, 0.58), p&lt;0.001; 0.41 (0.36, 0.46), p&lt;0.001; 0.37 (0.32, 0.42), p&lt;0.001; 0.36 (0.36, 0.31), p&lt;0.001; and 0.40 (0.34, 0.47), p&lt;0.001 for HDL-C 31–37 mg/dL, 38–45 mg/dL, 46–56 mg/dL, 57–69 mg/dL, and ≥70mg/dl, respectively]. Conclusions In a large longitudinal registry cohort of patients undergoing invasive coronary angiography, only very low HDL-C levels were associated with increased long-term mortality. We found no signs of a U-shaped association between HDL-C and prognosis. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Iryna Dykun was supported by the German Research Foundation (DY 149/2-1)Stefanie Hendricks was supported by the Universitätsmedizin Essen Clinician Scientist Academy (UMEA)

scholarly journals Long-term growth hormone (GH) replacement of adult GH deficiency (GHD) benefits the heart

2019 ◽  
Vol 181 (1) ◽  
pp. 79-91 ◽  
Author(s):  
A Ziagaki ◽  
D Blaschke ◽  
W Haverkamp ◽  
U Plöckinger
Keyword(s):  
Heart Failure ◽  
Growth Hormone ◽  
Gh Deficiency ◽  
Interventricular Septum ◽  
Standard Deviation Score ◽  
Left Ventricular ◽  
Amino Terminal ◽  
Gh Replacement

Objective Growth hormone (GH) deficiency is related to increased cardiovascular mortality. We studied clinical status, concentration of amino-terminal-pro B-type natriuretic-peptide (NT-proBNP) and echocardiographic parameters during long-term GH replacement (GH-R). Methods Fifty-one patients (29 females), 45.9 ± 11.3 years (mean ± s.d.), median follow-up 36.2 months, echocardiography and laboratory determinations initially and at 12-months intervals. Results At the last follow-up (last observation carried forward) (LFU (LOCF)) insulin-like growth-factor-1 standard deviation score (IGF-1 SDS) was ±1 in 92% of the patients. The median NT-proBNP declined significantly and stabilized (−40.5%) at LFU (LOCF) due to patients with a basal NT-proBNP >125 ng/L (indicative of heart failure). The basal NT-proBNP and the final IGF-1 SDS were significant predictors of the NT-proBNP at LFU (LOCF). Initially left ventricular enddiastolic diameter (LVEDD), left ventricular posterior wall diameter (LVPWD) and ejection fraction (EF) were normal, while interventricular septum diameter (IVSD) and left ventricular mass index (LVMi) were slightly increased. LVPWD and IVSD had significantly declined by year three. The LVMi was moderately to severely abnormal in 37.3 and 52.0% of patients initially and at LFU (LOCF). At LFU (LOCF) LVMi and IGF-1 were significantly correlated in the 14 male patients of this subgroup. Conclusion Long-term GH-R of GHD positively affected ISVD and LVPWD. In a subgroup of patients with severe GHD, LVMi increased concomitantly to the decline in NT-proBNP and this was positively correlated to the final IGF-1 concentration. Whether this observation indicates a positive development in a structurally altered heart muscle (reversal of adverse remodelling) or poses a future risk for heart failure needs further follow-up.

scholarly journals The LDL-C/HDL-C ratio and 4-year risk of coronary artery disease: a retrospective study

2020 ◽  
Author(s):  
shaohui zhang ◽  
Yongliang Zhao ◽  
Xiangting Li ◽  
Wen Dai ◽  
Xueying Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Syntax Score ◽  
Artery Disease

Abstract BackgroundNumerous studies have demonstrated that the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio can reflect the positive correlation index LDL-C and the negative index HDL-C of coronary artery disease (CAD) at the same time, which is increasingly considered as a novel marker to evaluate the risk of CAD. However, whether the short-term evaluation effect of the LDL-C/HDL-C ratio can be maintained during long-term follow-up is unclear. In addition, it is not clear whether the value of LDL-C/HDL-C ratio in the risk assessment of major adverse cardiac events (MACE) varies with different treatments. Our aim of the study was to investigate the link between LDL-C/HDL-C ratio and long-term risk of CAD and find out whether the LDL-C/HDL-C ratio could effectively evaluate the occurrence of MACE in CAD patients under different treatments. MethodsFrom May 2013 to November 2015, a total of 2409 patients who underwent coronary angiography (CAG) with or without revascularization therapy were enrolled in this study. They were divided into two groups based on the LDL-C/HDL-C ratio and three groups based on the treatments: medical therapy alone (MTA), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).ResultsIn total, 1784 patients (74.1%) were followed for health outcome and 625 patients (25.9%) experienced a MACE event. The median follow-up time was 4.27 years (1560 days). The patients with a higher LDL-C/HDL-C ratio (≥ 2.33) also had a significantly higher incidence of MACE (HR: 1.47, 95% CI: 1.25 to 1.72, p < 0.001). The cumulative incidence of rehospitalization for UA (HR: 1.53, 95% CI: 1.27 to 1.84, p < 0.001) and rehospitalization for HF (HR: 3.70, 95% CI: 1.22 to 22.25, p = 0.021) were significantly higher in high group than in low group. There were no significant differences in MI (HR: 1.25, 95% CI: 0.63 to 2.48, P = 0.521), TLR (HR: 0.98, 95% CI: 0.62 to 1.55, p = 0.947), Stroke (HR: 1.65, 95% CI: 0.64 to 4.25, p = 0.301) and 4-year all-cause death (HR: 1.45, 95% CI: 0.58 to 3.61, p = 0.423). Kaplan-Meier cumulative curve showed that patients with higher LDL-C/HDL-C ratio had a significantly lower MACE-free survival (p < 0.001). Multivariate Cox regression analysis demonstrated that LDL-C/HDL-C ratio (HR: 1.34, 95% CI: 1.14 to 1.60, p < 0.001) together with age, smoking, hypertension, diabetes mellitus, Syntax score and TG were independent predictors of 4-year MACE in the total CAD population (all p < 0.05). Further subgroup analysis showed that age, smoking, Syntax score, TG and LDL-C/HDL-C ratio were the independent predictors of MACE in MAT group (all p < 0.05); However, Syntax score and diabetes mellitus were the only independent predictor of MACE in PCI group and the CABG group, respectively (both p < 0.05). ConclusionsIn this study, we found that LDL-C/HDL-C ratio was an independent predictor of 4-year MACE in the total CAD population. The value of LDL-C/HDL-C ratio in assessing MACE risk varied among CAD patients with different treatments.

GH replacement therapy (GHRT) in adult patients with GH deficiency (GHD): a long term follow up

2018 ◽  
Author(s):  
Begona Pla Peris ◽  
Ana Maria Ramos-Levi ◽  
Clara Marijuan ◽  
Elena Fernandez ◽  
Nerea Aguirre ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Gh Deficiency ◽  
Adult Patients ◽  
Gh Replacement ◽  
Long Term Follow Up

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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