Metabolic perturbation in chronic heart failure: time to redress the balance?

Evaluation of: Jankowska EA, Biel B, Majda J et al. : Anabolic deficiency in men with chronic heart failure; prevalence and detrimental impact on survival. Circulation 114, 1829-1837 (2006). The study examined the circulating levels of three anabolic hormones (testosterone, insulin-like growth factor-1 and dehydroepiandrosterone sulfate) in 208 men with stable chronic heart failure and 366 healthy controls. A high prevalence of anabolic hormone deficiency (89% deficient in one or more hormone) was found in heart failure patients. Hormone levels were weakly related to disease severity and hormone deficiency independently predicted prognosis (a 3-year survival rate of 27% was found in subjects deficient in all three hormones). Although it cannot be concluded that anabolic hormone deficiency contributes to the disease process - it may simply reflect chronic disease with no physiological consequence - it is highly plausible that deficiency may at least contribute to symptomatology. Further studies evaluating anabolic hormone replacement for symptomatic improvement and possible prognostic benefit are warranted.