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Observational Study
. 2021 Feb 1;175(2):e205199.
doi: 10.1001/jamapediatrics.2020.5199. Epub 2021 Feb 1.

Association of Childhood Growth Hormone Treatment With Long-term Cardiovascular Morbidity

Anders Tidblad  1 , Matteo Bottai  2 , Helle Kieler  3 , Kerstin Albertsson-Wikland  4 , Lars Sävendahl  1
Affiliations
Observational Study

Association of Childhood Growth Hormone Treatment With Long-term Cardiovascular Morbidity

Anders Tidblad et al. JAMA Pediatr. .

Abstract

Importance: Concerns about the cardiovascular safety of recombinant human growth hormone (rhGH) treatment in childhood have recently been raised; however, long-term studies are limited.

Objective: To investigate the long-term risk of overall and severe cardiovascular events in patients previously treated with rhGH in childhood and whether there is an association with treatment duration or dose.

Design, setting, and participants: This nationwide population-based cohort study included patients treated with rhGH during childhood from January 1, 1985, to December 31, 2010, in Sweden, with follow-up through December 31, 2014. Included patients were treated with rhGH owing to isolated growth hormone deficiency (GHD), small for gestational age (SGA), and idiopathic short stature (ISS). For each patient, 15 age-, sex-, and region-based matched control individuals were randomly selected from the general population as a comparison group. Data on cardiovascular outcomes and covariates including gestational age, birth weight, birth length, socioeconomic status, and height were obtained through linkage with several health care and population-based registers. Data were analyzed from January 1, 1985, to December 31, 2014.

Exposures: Treatment with rhGH during childhood and adolescence (aged 0-18 years).

Main outcomes and measures: The primary outcome was the first cardiovascular event recorded after the start of follow-up, and the secondary outcome was the first severe cardiovascular event.

Results: A total of 53 444 individuals (3408 patients and 50 036 controls; 67.7% men; mean [SD] age at study end, 25.1 [8.2] years) were followed up for as long as 25 years (median follow-up, 14.9 [range, 0-25] years; total, 795 125 person-years). Among 1809 recorded cardiovascular events, the crude incidence rates were 25.6 events per 10 000 person-years for patients and 22.6 events per 10 000 person-years for controls. The adjusted hazard ratio (HR) for all cardiovascular events was higher in patients compared with controls (HR, 1.69; 95% CI, 1.30-2.19), especially for women (HR, 2.05; 95% CI, 1.31-3.20) compared with men (HR, 1.55; 95% CI, 1.12-2.13). All subgroups had increased HRs (SGA, 1.97 [95% CI, 1.28-3.04]; GHD, 1.66 [95% CI, 1.21-2.26]; and ISS, 1.55 [95% CI, 1.01-2.37]). Longer duration of rhGH treatment (HR, 2.08; 95% CI, 1.35-3.20) and total cumulative dose (HR, 2.05; 95% CI, 1.18-3.55) were associated with higher risk for overall cardiovascular disease. The adjusted HR for severe cardiovascular disease was 2.27 (95% CI, 1.01-5.12).

Conclusions and relevance: In this cohort study, treatment with rhGH during childhood due to GHD, SGA, or ISS was associated with increased risks of cardiovascular events in early adulthood, particularly in women; however, conclusions of causality are still limited and the absolute risk remains low.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tidblad reported receiving grants from the Society for Child Care and Stockholm County Council during the conduct of the study and personal fees from Pfizer, Inc, outside the submitted work. Dr Sävendahl reported receiving grants 20090376, 20120597, 20140566, 20150528, and 20170064 from Regional University Hospital and grants K2014-55X-22516 and 2015-02406 from Swedish Research Council during the conduct of the study; personal fees and nonfinancial support from Ascendis Pharma, personal fees from Hexal Pharmaceuticals and Merck & Co, and personal fees and nonfinancial support from Novo Nordisk A/S, Pfizer, Inc, and Sandoz outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flowchart of Study Inclusion
MPHD indicates multiple pituitary hormone deficiency; rhGH, recombinant human growth hormone.
See this image and copyright information in PMC

Comment in

References

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