Cardiovascular Risk Higher in Former Pediatric Recipients of
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Childhood growth hormone treatment is associated with an increased risk of cardiovascular events in early adulthood, although conclusions of causality are limited and the absolute risks are low, finds a new study published in JAMA.

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

This study aimed 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.

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. 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.

-- A total of 53444 individuals (3408 patients and 50036 controls; 67.7% men; mean age at study end, 25.1 years) were followed up for as long as 25 years (median follow-up, 14.9 years; total, 795125 person-years).

-- Among 1809 recorded cardiovascular events, the crude incidence rates were 25.6 events per 10000 person-years for patients and 22.6 events per 10000 person-years for controls.

-- The adjusted hazard ratio (HR) for all cardiovascular events was higher in patients compared with controls, especially for women compared with men.

-- All subgroups had increased HRs (SGA, 1.97; GHD, 1.66; and ISS, 1.55).

-- Longer duration of rhGH treatment and total cumulative dose were associated with higher risk for overall cardiovascular disease. The adjusted HR for severe cardiovascular disease was 2.27.

Conclusively, 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.