Cardiac cachexia: a systematic overview.
Cardiac cachexia as a terminal stage of chronic heart failure carries a poor prognosis. The definition of this clinical syndrome has been a matter of debate in recent years. This review describes the ongoing discussion about this issue and the complex pathophysiology of cardiac cachexia and chronic heart failure with particular focus on immunological, metabolic, and hormonal aspects at the intracellular and extracellular level. These include regulators such as neuropeptide Y, leptin, melanocortins, ghrelin, growth hormone, and insulin. The regulation of feeding is discussed as are nutritional aspects in the treatment of the disease. The mechanisms of wasting in different body compartments are described. Moreover, we discuss several therapeutic approaches. These include appetite stimulants like megestrol acetate, medroxyprogesterone acetate, and cannabinoids. Other drug classes of interest comprise angiotensin-converting enzyme inhibitors, beta-blockers, anabolic steroids, beta-adrenergic agonists, anti-inflammatory substances, statins, thalidomide, proteasome inhibitors, and pentoxifylline.
von Haehling
Stephan
S
Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. stephan.von.haehling@web.de
Lainscak
Mitja
M
Springer
Jochen
J
Anker
Stefan D
SD
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D045930:Anabolic Agents / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019167:Appetite Stimulants / Q000627:therapeutic use; D002100:Cachexia / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D006333:Heart Failure / Q000276:immunology / Q000378:metabolism / Q000628:therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D018529:Nutritional Support; D061988:Proteasome Inhibitors
D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D045930:Anabolic Agents; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019167:Appetite Stimulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D061988:Proteasome Inhibitors; D019382:Human Growth Hormone