Susana Gonzalez
Effects of growth hormone replacement on peripheral muscle and exercise capacity in severe growth hormone deficiency
Gonzalez, Susana; Sathyapalan, Thozhukat; Javed, Zeeshan; Atkin, Stephen L.
Authors
Professor Thozhukat Sathyapalan T.Sathyapalan@hull.ac.uk
Professor of Diabetes, Endocrinology and Metabolism
Zeeshan Javed
Stephen L. Atkin
Abstract
Aims
We evaluate prevalence of new abnormal glucose tolerance (AGT) in post-MI survivors without known diabetes (DM) if guidelines are followed and compare the ability of admission (APG), fasting (FPG) and 2-h post-load plasma glucose (2h-PG) to predict prognosis.
Methods
A total of 674 patients were followed up for 4 years for incidence of major adverse cardiovascular events (MACE) of cardiovascular death, non-fatal re-infarction or non-haemorrhagic stroke. Ability of models including APG, FPG and 2h-PG to predict MACE was compared.
Results
Of the total, 93–96% of impaired glucose tolerance and 64–75% of DM would be missed with current guidelines. MACE was higher in the upper quartiles of 2h-PG. When 2h-PG and FPG were included simultaneously in models, only 2h-PG predicted MACE (HR 1.12, CI 1.04–1.20, p = 0.0012), all cause mortality (HR 1.17, CI 1.05–1.30, p = 0.0039), cardiovascular mortality (HR 1.17, CI 1.02–1.33, p = 0.0205) and non-fatal MI (HR 1.10, CI 1.01–1.20, p = 0.0291). Adding 2h-PG significantly improved ability of models including FPG (χ2 = 16.01, df = 1, p = 0.0001) or FPG and APG (χ2 = 17.36, df = 1, p = 0.000) to predict MACE. Model including 2h-PG only had the lowest Akaike’s information criteria and highest Akaike weights suggesting that this was the best in predicting events. Adding 2h-PG to models including FPG or APG with other co-variates yielded continuous net reclassification improvement (NRI) of 0.22 (p = 0.026) and 0.27 (p = 0.005) and categorical NRI of 0.09 (p = 0.032) and 0.12 (p = 0.014), respectively. Adding 2 h-PG to models including only FPG, only APG and both yielded integrated discrimination improvement of 0.012 (p = 0.015), 0.022 (p = 0.001) and 0.013 (p = 0.014), respectively.
Conclusions
AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG.
Citation
Gonzalez, S., Sathyapalan, T., Javed, Z., & Atkin, S. L. (2018). Effects of growth hormone replacement on peripheral muscle and exercise capacity in severe growth hormone deficiency. Frontiers in endocrinology, 9(FEB), 56. https://doi.org/10.3389/fendo.2018.00056
Journal Article Type | Article |
---|---|
Acceptance Date | Feb 7, 2018 |
Online Publication Date | Feb 23, 2018 |
Publication Date | Feb 23, 2018 |
Deposit Date | Feb 23, 2018 |
Publicly Available Date | Feb 23, 2018 |
Journal | Frontiers in Endocrinology |
Print ISSN | 1664-2392 |
Electronic ISSN | 1664-2392 |
Publisher | Frontiers Media |
Peer Reviewed | Peer Reviewed |
Volume | 9 |
Issue | FEB |
Pages | 56 |
DOI | https://doi.org/10.3389/fendo.2018.00056 |
Keywords | GH deficiency; Succinate dehydrogenase; Cardiovascular risk factors; Exercise performance; Mitochondrial dysfunction |
Public URL | https://hull-repository.worktribe.com/output/625198 |
Publisher URL | https://www.frontiersin.org/articles/10.3389/fendo.2018.00056/full |
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Copyright Statement
© 2018 Gonzalez, Sathyapalan, Javed and Atkin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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