Muscle wasting and cachexia in heart failure: mechanisms and therapies

Abstract

Body wasting is a serious complication that affects a large proportion of patients with heart failure. Muscle wasting, also known as sarcopenia, is the loss of muscle mass and strength, whereas cachexia describes loss of weight. After reaching guideline-recommended doses of heart failure therapies, the most promising approach to treating body wasting seems to be combined therapy that includes exercise, nutritional counselling, and drug treatment. Nutritional considerations include avoiding excessive salt and fluid intake, and replenishment of deficiencies in trace elements. Administration of omega-3 polyunsaturated fatty acids is beneficial in selected patients. High-calorific nutritional supplements can also be useful. The prescription of aerobic exercise training that provokes mild or moderate breathlessness has good scientific support. Drugs with potential benefit in the treatment of body wasting that have been tested in clinical studies in patients with heart failure include testosterone, ghrelin, recombinant human growth hormone, essential amino acids, and β-adrenergic receptor agonists. In this Review, we summarize the pathophysiological mechanisms of muscle wasting and cachexia in heart failure, and highlight the potential treatment strategies. We aim to provide clinicians with the relevant information on body wasting to understand and treat these conditions in patients with heart failure.

Skeletal muscle wasting in chronic heart failure

“…It has been shown to increase functional capacity, muscle strength, and quality of life more compared with conventional aerobic exercise. 103 However, a large meta-analysis showed that patients receiving GH were significantly more likely to experience side effects such as soft tissue oedema, arthralgias, carpal tunnel syndrome, and gynecomastia. 96 Testosterone levels decline at the rate of 1% per year from 30 years of age leading to a reduction in muscle mass and strength, 97 The waning of testosterone appears to primarily decrease lower-limb muscle function, 69 making replacing it a seemingly perfect choice to treat sarcopenia.…”

Sarcopenia: Prevalence and Prognostic Implications in Elderly Patients with Cardiovascular Disease

“…In addition, the number of patients with sarcopenia has been suggested to increase over the next 30 years [17]. Therefore, it is becoming a major public health issue [18].…”

Metabolic disorders in heart failure and cancer

“…[96][97][98] Cachexia occurs when the physiological balance between anabolic and catabolic signalling is dysregulated. 65,101,102 Lately, an analysis of the COPERNICUS 103 trial has shown that carvedilol has the potential to stop and partially reverse wasting in cachectic patients with severe CHF (left ventricular ejection fraction <25% and dyspnoea at rest or during minimal work). Possible new biomarkers for the diagnosis of cachexia include pre-albumin, as a potential indicator of undernutrition and low-cholesterol levels, as an indicator of worse prognosis in CHF patients.…”