Published online before print October 9, 2006, doi: 10.1161/CIRCULATIONAHA.106.649426
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;114:1829-1837.)
© 2006 American Heart Association, Inc.
Heart Failure |
Anabolic Deficiency in Men With Chronic Heart Failure
Prevalence and Detrimental Impact on Survival
From Cardiology Department, Military Hospital (E.A.J., B.B., J.M., W.B., P.P.), Wroclaw, Poland; Institute of Anthropology, Polish Academy of Sciences (E.A.J., A.S., M.L.), Wroclaw, Poland; Cardiac Medicine, Royal Brompton Hospital (E.A.J., S.D.A., P.A.P.-W.), National Heart and Lung Institute, Imperial College London, London, United Kingdom; Endocrinology and Diabetology Department, Wroclaw Medical University (M.M.), Wroclaw, Poland; and Division of Applied Cachexia Research, Department of Cardiology, Charité (S.D.A.), Berlin, Germany.
Correspondence to Ewa A. Jankowska, MD, PhD, Cardiology Department, Military Hospital, ul. Weigla 5, 50-981 Wroclaw, Poland. E-mail Ewa.Jankowska{at}antro.pan.wroc.pl
Received January 31, 2005; de novo received July 3, 2006; accepted August 11, 2006.
Background— The age-related decline of circulating anabolic hormones in men is associated with increased morbidity and mortality. We studied the prevalence and prognostic consequences of deficiencies in circulating total testosterone (TT) and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and insulin-like growth factor-1 (IGF-1) in men with chronic heart failure (CHF).
Methods and Results— Serum levels of TT, DHEAS, and IGF-1 were measured with immunoassays in 208 men with CHF (median age 63 years; median left ventricular ejection fraction 33%; New York Heart Association class I/II/III/IV, 19/102/70/17) and in 366 healthy men. Serum levels of free testosterone were estimated (eFT) from levels of TT and sex hormone binding globulin. Deficiencies in DHEAS, TT, eFT, and IGF-1, defined as serum levels at or below the 10th percentile of healthy peers, were seen across all age categories in men with CHF. DHEAS, TT, and eFT were inversely related to New York Heart Association class irrespective of cause (all P<0.01). DHEAS correlated positively with left ventricular ejection fraction and inversely with N-terminal pro-brain natriuretic peptide (both P<0.01). Circulating TT, eFT, DHEAS, and IGF-1 levels were prognostic markers in multivariable models when adjusted for established prognostic factors (all P<0.05). Men with CHF and normal levels of all anabolic hormones had the best 3-year survival rate (83%, 95% CI 67% to 98%) compared with those with deficiencies in 1 (74% survival rate, 95% CI 65% to 84%), 2 (55% survival rate, 95% CI 45% to 66%), or all 3 (27% survival rate, 95% CI 5% to 49%) anabolic endocrine axes (P<0.0001).
Conclusions— In male CHF patients, anabolic hormone depletion is common, and a deficiency of each anabolic hormone is an independent marker of poor prognosis. Deficiency of >1 anabolic hormone identifies groups with a higher mortality.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  N. Gavrilova and S. T. Lindau Salivary Sex Hormone Measurement in a National, Population-Based Study of Older Adults J Gerontol B Psychol Sci Soc Sci, November 1, 2009; 64B(suppl_1): i94 - i105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Caminiti, M. Volterrani, F. Iellamo, G. Marazzi, R. Massaro, M. Miceli, C. Mammi, M. Piepoli, M. Fini, and G. M.C. Rosano Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure a double-blind, placebo-controlled, randomized study. J. Am. Coll. Cardiol., September 1, 2009; 54(10): 919 - 927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Cittadini, L. Saldamarco, A. M. Marra, M. Arcopinto, G. Carlomagno, M. Imbriaco, D. Del Forno, C. Vigorito, B. Merola, U. Oliviero, et al. Growth Hormone Deficiency in Patients with Chronic Heart Failure and Beneficial Effects of Its Correction J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3329 - 3336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Jankowska, P. Rozentryt, B. Ponikowska, O. Hartmann, D. Kustrzycka-Kratochwil, K. Reczuch, J. Nowak, L. Borodulin-Nadzieja, L. Polonski, W. Banasiak, et al. Circulating Estradiol and Mortality in Men With Systolic Chronic Heart Failure JAMA, May 13, 2009; 301(18): 1892 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Friedrich, R. Haring, M. Nauck, J. Ludemann, D. Rosskopf, E. Spilcke-Liss, S. B. Felix, M. Dorr, G. Brabant, H. Volzke, et al. Mortality and Serum Insulin-Like Growth Factor (IGF)-I and IGF Binding Protein 3 Concentrations J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1732 - 1739. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. R. Desai, S. Cheng, A. Nohria, F. Halperin, and R. P. Giugliano When Past Is Prologue N. Engl. J. Med., March 5, 2009; 360(10): 1016 - 1022. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Sacca Heart Failure as a Multiple Hormonal Deficiency Syndrome Circ Heart Fail, March 1, 2009; 2(2): 151 - 156. [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Cappola, Q.-L. Xue, and L. P. Fried Multiple Hormonal Deficiencies in Anabolic Hormones Are Found in Frail Older Women: The Women's Health and Aging Studies J Gerontol A Biol Sci Med Sci, February 1, 2009; 64A(2): 243 - 248. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Andreassen, I. Raymond, C. Kistorp, P. Hildebrandt, J. Faber, and L. O. Kristensen IGF1 as predictor of all cause mortality and cardiovascular disease in an elderly population Eur. J. Endocrinol., January 1, 2009; 160(1): 25 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Jankowska, J. Jakubaszko, A. Cwynar, J. Majda, B. Ponikowska, D. Kustrzycka-Kratochwil, K. Reczuch, L. Borodulin-Nadzieja, W. Banasiak, P. A. Poole-Wilson, et al. Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants Eur J Heart Fail, January 1, 2009; 11(1): 28 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Cappola, M. Maggio, and L. Ferrucci Is Research on Hormones and Aging Finished? No! Just Started! J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2008; 63(7): 696 - 698. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Maggio, F. Lauretani, G. P. Ceda, S. Bandinelli, S. M. Ling, E. J. Metter, A. Artoni, L. Carassale, A. Cazzato, G. Ceresini, et al. Relationship Between Low Levels of Anabolic Hormones and 6-Year Mortality in Older Men: The Aging in the Chianti Area (InCHIANTI) Study Arch Intern Med, November 12, 2007; 167(20): 2249 - 2254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Pascual-Figal, P. L. Tornel, and M. Valdes Letter by Pascual-Figal et al Regarding Article, "Anabolic Deficiency in Men With Chronic Heart Failure: Prevalence and Detrimental Impact on Survival" Circulation, May 29, 2007; 115(21): e548 - e548. [Full Text] [PDF]
|
|
|
|
|
|
E. A. Jankowska, B. Biel, J. Majda, W. Banasiak, P. Ponikowski, M. Lopuszanska, A. Szklarska, S. D. Anker, P. A. Poole-Wilson, and M. Medras Response to Letter Regarding Article, "Anabolic Deficiency in Men With Chronic Heart Failure: Prevalence and Detrimental Impact on Survival" Circulation, May 29, 2007; 115(21): e549 - e549. [Full Text] [PDF]
|
|