Cardiovascular risk and glucocorticoids: a Dutch National Registry of growth hormone treatment in adults with growth hormone deficiency analysis.

At baseline, AI patients had higher levels of total and LDL cholesterol compared to non-AI patients.

• GHD patients were grouped by presence (AI; N = 1836) or absence (non-AI; N = 750) of concomitant adrenal insufficiency.
• Both total cholesterol and LDL cholesterol differences were statistically significant (both p < 0.01).
• Data sourced from the Dutch National Registry of Growth Hormone Treatment in adults.
• This was a retrospective nationwide cohort study.

During growth hormone replacement therapy (GHRT), AI patients were more likely to use cardiovascular drugs than non-AI patients.

• The difference in cardiovascular drug use was statistically significant (p ≤ 0.01).
• Despite greater cardiovascular drug use, no worse outcomes were found for blood pressure, body composition, lipid metabolism, or glucose metabolism during GHRT.
• The AI group comprised N = 1836 patients and the non-AI group N = 750 patients.

In unadjusted models, AI patients had a higher risk of developing peripheral arterial disease and non-fatal cerebrovascular events.

• The hazard ratio for peripheral arterial disease in AI patients was HR 2.22 [95% CI 1.06–4.65].
• The hazard ratio for non-fatal cerebrovascular events in AI patients was HR 3.47 [95% CI 1.60–7.52].
• These differences disappeared in models adjusted for baseline differences, suggesting confounding by baseline cardiovascular risk factors.
• This indicates that baseline risk factors, rather than glucocorticoid replacement itself, may account for the elevated event rates.

After adjustment for baseline differences, there was no clear evidence that concomitant adrenal insufficiency with glucocorticoid replacement therapy leads to worse cardiovascular outcomes in GHD patients.

• The elevated hazard ratios for peripheral arterial disease and cerebrovascular events were no longer statistically significant after adjustment for baseline characteristics.
• No significant differences were found in blood pressure, body composition, lipid metabolism, or glucose metabolism between AI and non-AI groups during GHRT.
• The authors note that lack of statistical power, the role of other risk factors, and inability to distinguish between glucocorticoid treatment regimens may have influenced outcomes.
• The authors conclude that 'glucocorticoid replacement therapy in AI may be safer than previously thought.'

Patients with hypopituitarism are considered at increased cardiovascular risk due to both growth hormone deficiency and potential overuse of glucocorticosteroids in concomitant adrenal insufficiency.

• The study was motivated by the hypothesis that overuse of glucocorticosteroids in concomitant AI contributes to elevated cardiovascular risk in hypopituitary patients.
• Prior literature suggests glucocorticoid overuse as a contributing factor to cardiovascular risk in this population.
• The study design aimed to test whether AI patients on glucocorticoid replacement had worse cardiovascular outcomes than those without AI.