The metabolic syndrome (MetS) in 2610 GH deficient (GHD) subjects before GH replacement: a KIMS (Pfizer International Metabolic Database) analysis
Johan Verhelst1, Anders F Mattsson2, Anton Luger3, Maria Thunander4,7, Miklos Goth5, Maria Koltowska-Haggstrom2 & Roger Abs6
Objective: To identify MetS and non-MetS in subjects with adult-onset GHD before start of GH replacement and to compare prevalence of cardiovascular risk factors.
Subjects and methods: MetS was defined (IDF criteria) by the obligatory presence of increased waist circumference (WC) and presence of at least two of following components: hypertension, decreased HDL-cholesterol, increased triglycerides, diabetes mellitus. The complementary group was defined as non-MetS.
The KIMS study population of 2610 subjects comprised 1243 (47.6%) MetS (51% males, mean age 49.6±12.5 years, BMI 31.3±5.2 kg/m2) and 1367 (52.4%) non-MetS (51% males, mean age 45.5±13.6 years, BMI 27.0±5.0 kg/m2) subjects. Regression analyses with adjustment for age, gender and BMI were done of relevant variables before start of GH treatment.
Results: The MetS group versus non-MetS group was characterized by: WC 101.6 vs 98.7 cm, HDL-cholesterol 1.07 vs 1.40 mmol/l, triglycerides 2.94 vs 1.66 mmol/l, blood pressure 134/83 vs 128/78 mmHg (P<0.0001 for all). MetS group had longer estimated GHD duration (P<0.05). With increasing number of MetS components, an adverse trend for GHD duration (P<0.01), waist-hip ratio (P<0.0001), WC (P<0.001), HDL-cholesterol (P<0.0001), triglycerides (P<0.0001), and blood pressure (P<0.0001) was observed. No significant differences were found for IGF1 SDS, lean or fat mass, total or LDL-cholesterol. Presence of MetS was not influenced by country of origin, aetiology of GHD, previous radiotherapy, existence of isolated GHD, or number of additional pituitary deficiencies. History of cardiovascular (×2) and cerebrovascular (×1.5) disorders and diabetes mellitus (×4.5) were more frequently encountered in the MetS group.
Conclusion: In this KIMS population of adult-onset GHD, the metabolic syndrome was more frequently encountered than in the general population, and subjects with Mets were characterized by more adverse cardiovascular risk factor profile, an increased frequency of vascular complications and diabetes mellitus before start of GH replacement.