(Circulation. 1996;93:2135-2141.)
© 1996 American Heart Association, Inc.
Articles |
Randomized, Double-Blind, Placebo-Controlled Study of Supplemental Oral L-Arginine in Patients With Heart Failure
From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis.
Correspondence to Thomas S. Rector, PhD, Box 508 UMHC, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455.
Background Patients with heart failure have reduced peripheral blood flow at rest, during exercise, and in response to endothelium-dependent vasodilators. Nitric oxide formed from L-arginine metabolism in endothelial cells contributes to regulation of blood flow under these conditions. A randomized, double-blind crossover study design was used to determine whether supplemental oral L-arginine can augment peripheral blood flow and improve functional status in patients with moderate to severe heart failure.
Methods and Results Fifteen subjects were given 6 weeks of oral L-arginine hydrochloride (5.6 to 12.6 g/d) and 6 weeks of matched placebo capsules in random sequence. Compared with placebo, supplemental oral L-arginine significantly increased forearm blood flow during forearm exercise, on average from 5.1±2.8 to 6.6±3.4 mL·min-1·dL-1 (P<.05). Furthermore, functional status was significantly better on L-arginine compared with placebo, as indicated by increased distances during a 6-minute walk test (390±91 versus 422±86 m, P<.05) and lower scores on the Living With Heart Failure questionnaire (55±28 versus 42±26, P<.05). Oral L-arginine also improved arterial compliance from 1.99±0.38 to 2.36±0.30 mL/mm Hg (P<.001) and reduced circulating levels of endothelin from 1.9±1.1 to 1.5±1.1 pmol/L (P<.05).
Conclusions Supplemental oral L-arginine had beneficial effects in patients with heart failure. Further studies are needed to confirm the therapeutic potential of supplemental oral L-arginine and to identify mechanisms of action in patients with heart failure.
Key Words: heart failure • endothelium • L-arginine
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