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

Cardiovasc Ther. Fall 2009;27(3):187-93. doi: 10.1111/j.1755-5922.2009.00094.x.

Abstract

Chronic heart failure (CHF) involves derangements in multiple neurohormonal axes leading to a procatabolic state and wasting syndrome associated with significant mortality. Catabolic abnormalities include excess catecholamines and glucocorticoids. Anabolic defects include deficiencies of sex steroids, insulin resistance, and growth hormone (GH) resistance. These abnormalities are also correlated with increased morbidity and mortality in CHF. Anabolic axes have been augmented in pilot studies in CHF with testosterone, GH, insulin-like growth factor-1, and GH secretagogues. Results have been varied although some treatments have been associated with improved surrogate endpoints. This review article explores the current understanding of metabolic derangements in CHF and highlights potential neuroendocrine treatment strategies.

Publication types

  • Review

MeSH terms

  • Anabolic Agents / metabolism
  • Animals
  • Catecholamines / metabolism
  • Glucocorticoids / metabolism
  • Heart / drug effects*
  • Heart Failure / drug therapy*
  • Heart Failure / metabolism
  • Human Growth Hormone / physiology
  • Humans
  • Insulin Resistance
  • Neurosecretory Systems / drug effects*
  • Neurosecretory Systems / metabolism
  • Steroids / metabolism

Substances

  • Anabolic Agents
  • Catecholamines
  • Glucocorticoids
  • Steroids
  • Human Growth Hormone