It was a great pleasure indeed to accept the invitation to work on this book about 'cardiovascular topics in endocrinology'. Having worked in this field of research for many years, it is still fascinating to dive into the ever-expanding knowledge about the interactions between the endocrine and cardiovascular systems.A\One of the personal landmarks in this field was published in 1994 in a paper in which cardiovascular abnormalities were described in adult patients with growth hormone (GH) deficiency, and substitution therapy with GH improved a number of cardiac and vascular variables. In the Discussion, the authors speculated that GH might play a future role in the treatment of heart failure. This triggered a lot of research activities with successful GH treatment in different animal models with heart failure. Moreover, a pioneering study from Naples published in the New England Journal of Medicine in 1998 reported spectacular improvements in a small number of patients with heart failure treated with GH for 3 months. Since then, for various reasons, no major, large, placebo-controlled trial confirming these positive results has been published. However, this particular field is still being explored and recent studies point to multiple hormonal deficiencies in subsets of patients with heart failure.A\It is important to note that almost all endocrine diseases, if not treated or controlled, have cardiovascular manifestations. Interestingly, not only GH deficiency but also GH excess is harmful for cardiovascular functions, e.g. in acromegaly, where shortened life expectancy and increased mortality is mostly due to cardiovascular complications in uncontrolled disease. Moreover, Cushing's syndrome and diabetes are well-known metabolic and cardiovascular manifestations, as well as hypo- and hyper thyroidism. In recent years, both adipose tissue and the heart have been increas ingly recognized as organs with partial endocrine functions, which produce adipo-kines and brain natriuretic peptide, respectively, and influence a number of cardio-vascular parameters. Primary aldosteronism as a cause for secondary hypertension is still a great challenge to detect and diagnose properly; however, new important discoveries have been made regarding the genetics of this probably underestimated cause of hypertension.A\Hormones as treatment tools are also a controversial topic in many areas where solid, large, randomized, prospective trials are lacking or provide conflicting results.The increased use of testosterone in partially androgen-deficient middle-aged and elderly men is a challenge for health care systems and the scientific community since it is still unclear if benefits outweigh risks and costs for such treatment. Hormones such as incretins or ghrelin have potentially beneficial and protective cardiovascular effects and warrant more and larger controlled trials to confirm their potential as treatment tools in metabolic and cardiovascular diseases. Replacement therapy with hormones for postmenopausal women and glucocorticoids in the treatment of adrenal insufficiency has had a long tradition in modern medicine. However, important cardiovascular complications related to treatment have been recognized and need to be addressed for long-term safety in these patient groups.A\We are very grateful to the authors who contributed interesting chapters to this book with excellent and up to-date reviews of their respective scientific field. All of them have contributed with landmark findings in this particular topic of research and we are very proud to have them all aboard on this book project. It is now our hope that this book will provide important new knowledge in cardiovascular endocrinology and that it will also inspire new scientific endeavors in this ever-evolving and-expanding field in medicine. Jorgen Isgaard, Gothenburg, Riccarda Granata, Turin

Foreword VII

Preface IX

Testosterone and Cardiovascular Risk in Men 1

Hormone Therapy and Venous Thromboembolism among Postmenopausal Women 21

Cardiovascular and Metabolic Impact of Glucocorticoid Replacement Therapy 33

Cardiovascular Disease and Thyroid Function 45

Hormonal Alterations in Heart Failure: Anabolic Impairment in Chronic Heart Failure - Diagnostic, Prognostic and Therapeutic Issues 57

Genetics of Primary Aldosteronism 70

Adipose Tissue Dysfunction and Inflammation in Cardiovascular Disease 79

Potential Peptides in Atherosclerosis Therapy 93

Interaction between Insulin-Like Growth Factor-1 and Atherosclerosis and Vascular Aging 107

Ghrelin and the Cardiovascular System 125

Natriuretic Peptide System and the Heart 134

Beyond Glycemic Control: Cardiovascular Effects of Incretin-Based Therapies 144

Author Index 158

Subject Index 159

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