How corticoids, growth hormone and oestrogens influence lipids and atherosclerosis
Authors:
J. Marek; V. Hána; M. Kršek
Authors‘ workplace:
III. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in:
Vnitř Lék 2007; 53(4): 386-390
Category:
Review
Overview
The hormones with a strong influence on the lipid spectrum and the development of atherosclerosis include cortisol, growth hormone and oestrogens. Cortisol accelerates atherosclerosis both through dyslipidemia and through an increase in visceral fat, hypertension, increased insulin resistance and the development of reduced glucose tolerance which may result in diabetes mellitus. Even when a cortisol excess disappears, as is the case of patients cured of Cushing syndrome, arterial walls remain permanently vulnerable to the atherosclerotic process. In conditions involving a lack of growth hormone, dyslipidemia develops and increases the burden on the cardiovascular system if not treated in a timely manner by the substitution of growth hormone. Oestrogens have a double effect: they have an anti-atherogenic effect on artery walls that are not yet damaged by an atherosclerotic process, but where atherosclerosis has already developed they have a prothrombotic effect and destabilise the atheromatous plaques. If oestrogen is to be used as protection against the onset of atherogenesis, it is necessary to start in a period when the atherosclerotic process has not yet begun to damage the woman’s arterial walls and it is best to use natural hormones (estradiol) and to prevent endometriosis it should be combined with crystalline progesterone applied locally – inravaginally. Oestrogens should be given in small doses, preferably parenterally. Even this will not prevent genetic oestrogen effects though.
Key words:
fats – atherosclerosis – cortisol – Cushing syndrome – growth hormone – acromegaly – oestrogens
Sources
1. Etxabe J, Vazquez JA. Morbidity and mortality in Cushing’s disease: an epidemiological approach. Clin Endocrinol 1994; 23: 479-448.
2. Colao A, Pivonello R, Spiezia S et al. Persistence of increased cardiovascular risk in patients with Cushing’s disease after five years of successful cure. J Clin Endocrinol Metab 1999; 84: 2664-2672.
3. Ježková J, Marek J, Prázný M et al. Vliv hyperkortizolismu na vznik a vývoj aterosklerotických cévních změn. Vnitř Lék 2003; 49: 656-667.
4. Friedman TC, Mastorakos G, Newman TD et al. Carbohydrate and lipid metabolism in endogenous hypercortisolism: shared features with metabolic syndrome X and NIDDM. Endocr J 1996; 43: 645-655.
5. Mancini T, Kola B, Mantero F et al. High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol 2004; 61: 768-777.
6. Reincke M. Subclinical Cushing’s syndrome. Endocrinol Metab Clin North Am 2000; 29: 43-46.
7. Tauchmanova L, Rossi R, Biondi B et al. Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 2002; 87: 4872-4878.
8. Prázný M, Ježková J, Horová E et al. Impaired microvascular reactivity and endothelial function in patients with Cushing’s syndrome. Physiol Res 2007; Epub ahead of print.
9. Cuneo RC, Salomon F, Watts GF et al. Growth hormone treatment improves serum lipids and lipoproteins in adults with growth hormone deficiency. Metab Clin Exp 1993; 42: 1519 - 1523.
10. Colao A, Di Somma C, Cuocolo A et al. Improved cardiovascular risk factors and cardiac performance after 12 months of growth hormone (GH) in young adult patients with GH deficiency. J Clin Endocrinol Metab 2001; 86: 1874-1881.
11. Rosen T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990; 336: 285-288.
12. Markussis V, Beshyah SA, Fisher C et al. Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary results. Lancet 1992; 340, 1188-1192.
13. Christ ER, Cummings MH, Albany E et al. Effects of growth hormone (GH) replacement therapy on very low density lipoprotein apolipoprotein B 100 kinetics in patients with adult GH deficiency: a stable isotope study. J Clin Endocrinol Metab 1999; 84: 307-316.
14. Florakis D, Hung V, Kaltas G et al. Sustained reduction in circulating cholesterol in adult hypopituitary patients given low dose titrated growth hormone replacement therapy: a two year study. Clin Endocrinol (Oxf) 2000; 53: 453-459.
15. Law MR, Vald NJ, Wu T et al. Systematic underestimation of association between serum cholesterol concentration and ischeamic heart diease in observational studies: data from the BUPA study. British Med J 1994; 308: 363-366.
16. Weaver JU, Monson JP, Noonan K et al. The effect of low dose recombinant human growth hormone replacement on regional fat distribution, insulin sensitivity, and cardiovascular risk factors in hypopituitary adults. J Clin Endocrinol Metab 1995; 80: 153- 159.
17. O’Halloran DJ, Wieringa G, Tsatsoulis A et al. Increased serum lipoprotein (a) concentrations after GH treatment in patients with isolated GH deficiency. Ann Clin Biochem 1996; 33: 330-334.
18. Wieringa G, Toogood AA, Ryder WD et al. Changes in lipoprotein (a) levels measured by six kit methods during growth hormone treatment of growth - hormone deficient adults. Growth Hormone IGF Res 2000; 10: 14-19.
19. Maldonado Castro GF, Escobar-Morreale HF, Ortega H et al. Effects of normalization of GH hypersecretion on lipoprotein (a) and other lipoprotein serum levels in acromegaly. Clin Endocrinol (Oxf.) 2000; 53: 313-319.
20. Parkinson C, Drake WM, Wieringa G et al. Serum lipoprotein changes following IGF1 normalization using a growth hormone receptor antagonist in acromegaly. Clin Endocrinol (Oxf.) 2002; 56: 303-311.
21. Tan KC, Shiu SW, Janus ED et al. LDL subfractions in acromegaly: relation to growth hormone and insulin-like growth factor-1. Atherosclerosis 1997; 129: 59-65.
22. Colao A, Di Somma C, Savanelli MC et al. Beginning to end: Cardiovascular implications of growth hormone (GH) and GH therapy. Growth hormone IGF Res 2006; 16, Suppl A: S41.8.
23. Van der Schouw YT, van der Graaf Y, Styerberg EW et al. Age at menopause as a risk factor for cardiovascular mortality. Lancet 1996; 347: 714-718.
24. Grodstein F, Manson JE, Colditz GA et al. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000; 133: 993-941.
25. Marek J. Význam ovariálních a testikulárních steroidů v metabolismu lipidů a v aterogenezi. Vnitř Lék 1992; 38: 913-920.
26. Dubey RK, Imthurn B, Zacharia LC et al. Hormone replacement therapy and cardiovascular disease: What went wrong and where do we go from here? Hypertension 2004; 44: 789-795.
27. Rossouw JE, Anderson GL, Prentice REL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Womens´Health Iniciative randomized controlled trial. J Amer Med Ass 2002; 2188: 321-333.
28. Hulley S, Grady D, Bush T et al. Randomised trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Replacement Study (HERS) Research Group. J Amer Med Ass 1998; 280: 605-613.
29. Ouyang P, Michos ED, Karas RH et al. Hormone replacement therapy and the cardiovasular system. Lessons learned and unanswered questions. J Amer Coll Cardiol 2006; 47: 1741-1753.
30. Harman SM, Brinton EA, Cedars M et al. KEEPS the Kronos Early Estrogen Prevention Study. Climacteric 2005; 8: 3-12.
31. Klaiber EL, Vogel W, Rako S. A crique of the Women’s Health Initiative hormone therapy study. Fert Steril 2005; 84: 1589-1601.
32. Phillips LS, Langer LD. Postmenopausal hormone therapy: Critical reappraisal and a unified hypothesis. Fert Steril 2005; 83: 558-566.
33. Tofovic S, Dubey RK, Jackson EK. 2-hydroxyestradiol attenuates the development of obesity, the metabolic syndrome, and vascular and renal dysfunction in obese ZSF1 rats. J Phamacol Exper Therap 2001; 299: 973-977.
34. Menon DV, Vongpatanasin W. Effects of transdermal estrogen replacement therapy on cardiovascular risk factors. Treat Endocrinol 2006; 5: 37-51.
35. Herrington DM, Howard TD, Hawkins GA et al. Estrogen-receptor polymorphism and effects of estrogen replacement on high-density lipoprotein cholesterol in women with coronary disease. N Engl J Med 2002; 346: 967-974.
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Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
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