Pediatric growth hormone therapy is linked to adulthood CV events

  • Tidblad A & al.
  • JAMA Pediatr
  • 21/12/2020

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Growth hormone treatment in childhood is linked to an increased risk for cardiovascular (CV) events in adulthood, although the absolute risks are low.
  • Treatment duration correlated with risk.

Why this matters

  • Editorial: ethically acceptable risk thresholds vary depending on indication for growth hormone treatment, with differences between treating healthy children who want to be taller and those whose growth hormone deficiency carries health risks.

Key results

  • Included 3408 patients treated with growth hormone and 50,036 untreated (32.3% women).
    • Average age at treatment start was 9.3 years.
    • Median follow-up was 14.9 (range 0-25) years.
  • Crude CV incidence rates:
    • 25.6 treated vs 22.6 untreated per 10,000 person-years.
    • 32.2 vs 23.2 per 10,000 person-years among female participants.
  • Male participants in the 2 groups had similar incidence rates.
  • Severe CV event risk also was higher among patients, except in the most restricted model.
  • Time to first event analyses showed increased risk with treatment history vs without, more so among female patients.
  • Treatment duration was linked to increased risk (P=.01 for trend).

Study design

  • Nationwide population-based cohort study.
  • Included all patients who had growth hormone treatment in Sweden during January 1, 1985-December 31, 2010, for medical indications.
  • Funding: Swedish Research Council; others.

Limitations

  • Confounding possible.
  • Low rate of events.
  • Cohort is still young.