Growth hormone recipients are at increased risk for a small increase in heart risk into adulthood.
Children who have been given growth hormone face a rather high risk of heart-related diseases when they reach adulthood, according to a large study from Sweden.
In the context of the annual event for 442 patients not receiving Growth Hormone therapy, the risk increased to 1/391 for 3,408 Growth Hormone-treated patients, the risk increased significantly, reaching 69 %
Women face twice the risk, with a hazard ratio of 2.05 compared with 1.55 for men, as reported in JAMA Pediatrics. The longer the treatment and the higher the cumulative dose, the greater the risk of heart arrhythmias, high blood pressure, stroke, and other problems.
However, it is difficult to predict whether the increased risk is directly attributable to treatment or to underlying problems at the outset of therapy.
“This is important to remember when assessing an individual’s risk,” lead author Dr Anders Tidblad of the Karolinska Institutet in Stockholm told Reuters Health by email. “What is presented is an association and not of causal explanatory value. We still do not know for sure if there are other underlying causes observed for increased risk, even if we did our best to address this issue by having a similar comparison group. as possible and correct for significant variations.
An early French study published in 2012 warned of the possibility of death from cardiovascular disease and cerebrovascular disease.
Dr Tidblad, head of pediatric endocrinology at Karolinska University Hospital, said: “I believe the French study has stirred anxiety in the community and may temporarily have a negative impact on initiation. new treatment. But the difficulty of drawing firm conclusions from the above study has kept the effect from having much of an impact.”
He predicts that “Pediatric endocrinologists will welcome our study and appreciate our efforts to address this issue and conclude that we need to remain vigilant with potential long-term effects of this treatment.”
“But for the individual patient, the absolute risk of a cardiovascular event beyond the age of 40 is low,” he said. Patients should not be overly concerned by our results.”
There were 3,408 patients in the cohort who received growth hormone injections at any time between 1985 and 2010. Each patient was matched with 15 control patients by the Swedish national system. Two-thirds of the study participants were men. They were followed up to the end of 2014, for an average of 14.9 years.
The rationale for the treatment did not make a big difference in risk. Those diagnosed as younger for gestational age had a 97 percent increased risk. This rate was 66% higher in patients considered isolated growth hormone deficiency and 55% higher when diagnosed as idiopathic short stature.
Both growth hormone deficiency and have a quantity Excess growth hormone both increase the risk of cardiovascular problems.
In the new study, Dr. Tidblad’s team found that the longer the duration of growth hormone treatment, the greater the risk. It did not increase significantly during two years of treatment, but doubled over seven or more years of treatment.
Total cumulative growth hormone use was also significantly associated with more muscle gain. Adjusted hazard ratio of 2.27 (95% CI, 1.01 to 5.12) for severe cardiovascular disease, including aneurysm, ischemic heart disease, myopathy
heart failure, heart failure and cerebrovascular diseases.
“We found that the highest risk was among those with the longest duration of treatment and the highest cumulative dose, but no association with the mean daily dose. This finding could indicate a dose-response sequence but could also be caused by a potential heterogeneity among treated patients, where those with the longest duration of treatment and cumulative dose The highest accumulation also has the risk of fundamental increases for other reasons.”
“We will need to continue to monitor previously treated patients and over time we will have more information about the risks,” Dr. Tidblad said. “With longer follow-up, we will be able to say something about risk later in life and also more events that will improve our statistical ability for rare events.”
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Translator: Gia Tan.
Original link: www.medscape.com/viewarticle/942988
SOURCE: https://bit.ly/2WxtCZp and https://bit.ly/2KgFj4g JAMA Pediatrics, online December 21, 2020.
Anders Tidblad, MD, PhDfirst; Matteo Bottai, PhD, ScD2; Helle Kieler, MD, PhD3; et alKerstin Albertsson-Wikland, MD, PhD4; Lars Sävendahl, MD, PhDfirst
JAMA Pediatr. Published online December 21, 2020. doi:10.1001/jamapediatrics.2020.5199
Adda Grimberg, MD1.2
JAMA Pediatr. Published online December 21, 2020. doi:10.1001/jamapediatrics.2020.5232