Hormone deficiency and cardiovascular disease: clinical impact, treatment strategies and prognostic prediction.

Abstract

Introduction: Hormone deficiency states are increasingly recognized as important, yet often underappreciated, contributors to cardiovascular (CV) disease. Deficits affecting pituitary, thyroid, parathyroid, adrenal, and gonadal axes influence myocardial function, vascular biology, and metabolic homeostasis, leading to increased cardiovascular morbidity and mortality.

Areas covered: This narrative review summarizes current evidence on the CV impact of major hormonal deficiencies, including hypopituitarism, growth hormone deficiency, hypoprolactinemia, hypothyroidism, hypoparathyroidism, adrenal insufficiency, and hypogonadism. Hormone-specific CV phenotypes, underlying pathophysiological mechanisms, effects of replacement therapies, residual cardiovascular risk, and prognostic markers are discussed. The literature search was conducted in PubMed/MEDLINE and included studies published between January 2000 and December 2025, with emphasis on systematic reviews, meta-analyses, large observational cohorts, and key clinical trials.

Expert opinion: Despite advances in hormone replacement, many patients retain excess CV risk that is not captured by conventional prediction models. Endocrine-adapted risk stratification, individualized replacement strategies considering dose and chronobiology, and integration of emerging tools such as artificial intelligence - based models may improve risk prediction. Dedicated cardiovascular outcome trials in endocrine populations remain a major unmet need.