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Neuroendocrine effects on the heart and targets for therapeutic manipulation in heart failure

Parminder S Chaggar1, Chris J Malkin, Steven M Shaw

  • 1Northwest Heart and Transplant Centre, Wythenshawe Hospital, Manchester M23 9LT, UK. pchaggar@doctors.org.uk

Cardiovascular Therapeutics
|August 20, 2009
PubMed

Insights

Chronic heart failure (CHF) causes metabolic problems, including hormonal imbalances that worsen the condition and increase mortality. This review explores neuroendocrine treatments to address these catabolic and anabolic defects in CHF patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Medicine

Background:

  • Chronic heart failure (CHF) is characterized by neurohormonal axis dysfunction.
  • This dysfunction leads to a procatabolic state and wasting syndrome, increasing mortality.
  • Key abnormalities include elevated catecholamines/glucocorticoids and deficiencies in sex steroids, with insulin and growth hormone (GH) resistance.

Purpose of the Study:

  • To review the current understanding of metabolic derangements in CHF.
  • To highlight potential neuroendocrine treatment strategies for CHF.

Main Methods:

  • Literature review of studies on neuroendocrine axes in CHF.
  • Analysis of pilot studies augmenting anabolic axes (testosterone, GH, IGF-1, GH secretagogues).

Main Results:

  • Metabolic abnormalities in CHF are linked to increased morbidity and mortality.
  • Pilot studies using anabolic agents in CHF have shown varied results.
  • Some treatments demonstrated improvements in surrogate endpoints.

Conclusions:

  • Neuroendocrine dysregulation significantly impacts CHF pathophysiology and outcomes.
  • Targeting anabolic axes presents a potential therapeutic strategy for CHF.
  • Further research is needed to optimize neuroendocrine treatments for CHF.

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