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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

Susana Gonzalez

Thozhukat Sathyapalan

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.

Journal Article Type Article
Publication 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
APA6 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
DOI https://doi.org/10.3389/fendo.2018.00056
Keywords GH deficiency; Succinate dehydrogenase; Cardiovascular risk factors; Exercise performance; Mitochondrial dysfunction
Publisher URL https://www.frontiersin.org/articles/10.3389/fendo.2018.00056/full
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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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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