Adults born small for gestational age (SGA) are ideal candidates for growth hormone (GH) therapy to promote catch-up growth and increase adult height. However, the long-term consequences of GH treatment on cardiovascular risk and mortality remain unclear. Now, data from the first longitudinal study assessing cardiovascular risk factors in SGA adults has shown that long-term GH treatment had no unfavourable cardiovascular effects and improved lipid profiles during the 5 years after cessation of GH therapy.
The study included 199 SGA young adults who were treated with GH and three age-matched control groups (n = 285), including untreated SGA adults. Patients were evaluated for longitudinal changes in cardiovascular parameters at GH cessation, with follow-up at 6 months, 2 years and 5 years.
In SGA adults, mean systolic and diastolic blood pressure temporarily increased at 6 months after GH discontinuation (P < 0.001 for both comparisons), but returned to levels similar to baseline at 5 years (systolic, P = 0.126; diastolic, P = 0.455). At 5 years, non-significant increases in lipid concentrations were observed and carotid intima-media thickness (cIMT) remained unchanged. Compared with short SGA adults who were not treated with GH (n = 51), mean cholesterol (P = 0.0030) and LDL cholesterol (P < 0.0001) levels were markedly lower and mean blood pressure and cIMT were not significantly different (P > 0.12 for all comparisons) in the treated group at 5 years after cessation of GH therapy. In addition, mean blood pressure, cIMT and lipid concentrations of treated patients at 5 years after cessation were not different from those of untreated SGA adults with spontaneous catch-up growth (n = 92).
Overall, the findings offer important insight into the long-term cardiovascular health implications associated with GH therapy following treatment cessation in SGA adults.
van der Steen, M., Kerkhof, G.F., Smeets C.C.J. and Hokken-Koelega, A.C.S. Cardiovascular risk factors and carotid intima media thickness in young adults born small for gestational age after cessation of growth hormone treatment: a 5-year longitudinal study. Lancet Diabetes Endocrinol. http://dx.doi.org/10.1016/S2213-8587(17)30311-X (2017)
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Bradley, C. Long-term safety of growth hormone. Nat Rev Endocrinol 14, 3 (2018). https://doi.org/10.1038/nrendo.2017.155