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Prevalence of cachexia in chronic heart failure and characteristics of body composition and metabolic status

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Abstract

The prevalence of cardiac cachexia has previously been estimated to 8–42 %. However, novel treatment strategies for chronic heart failure (CHF) have improved and decreased morbidity and mortality. Therefore, we aimed to reassess the prevalence of cachexia in an outpatient CHF clinic and to characterize a CHF population with and without cachexia with respect to body composition and related biomarkers. From 2008 to 2011, we screened 238 optimally treated, non-diabetic CHF patients for cardiac cachexia, defined as unintentional non-oedematous weight loss of >5 % over ≥6 months. CHF patients (LVEF <45 %) with cachexia (n = 19) and without (n = 19) were compared to controls with prior myocardial infarction and left ventricular ejection fraction (LVEF) >45 % (n = 19). The groups were matched for age, sex, and kidney function. Body composition was assessed by dual energy X-ray absorptiometry. The prevalence of cachexia was 10.5 %. Abdominal fat ± SD (%) was reduced in cachectic CHF: 27.4 ± 10.0 versus 37.5 ± 10.6 % (CHF, no cachexia) and 40.6 ± 8.0 % (controls), (P < 0.001). NT-proBNP levels were inversely correlated to abdominal fat in a multivariate linear regression analysis adjusted for known predictors of NT-proBNP (LVEF and NYHA); (β = −0.28; P = 0.018). Myostatin levels were reduced in cachectic CHF compared to controls (P = 0.013). The prevalence of cachexia in stable CHF, treated according to recent guidelines, is lower than previously anticipated. Body alterations in cachexia consist mainly of reduced abdominal fat mass, and its inverse correlation to NT-proBNP suggests involvement of abdominal lipolysis. Our data do not support a role of circulating myostatin as a biomarker for muscle wasting.

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Acknowledgments

Thanks to the nurses at the CHF outpatient clinic at the Herlev University Hospital for their invaluable help of recruiting patients and thanks to the laboratory technicians at the Metabolic Ward, O4. The work was financially supported by The Research Council of Herlev University Hospital and The A.P. Moeller Foundation for the Advancement of Medical Science.

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Authors and Affiliations

  1. Department of Endocrinology, Herlev University Hospital, Herlev, Denmark

    Heidi Marie Christensen, Caroline Kistorp & Jens Faber

  2. Department of Cardiology, Herlev University Hospital, Herlev, Denmark

    Heidi Marie Christensen & Niels Keller

  3. Bispeengen 13, 3. tv, 2000, Frederiksberg, Denmark

    Heidi Marie Christensen

  4. Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

    Morten Schou

  5. Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Herlev, Denmark

    Bo Zerahn

  6. Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark

    Jan Frystyk

  7. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

    Jan Frystyk

  8. Department of Medicine, Glostrup University Hospital, Glostrup, Denmark

    Peter Schwarz

  9. Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark

    Peter Schwarz & Jens Faber

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  1. Heidi Marie Christensen
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Correspondence to Heidi Marie Christensen.

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Christensen, H.M., Kistorp, C., Schou, M. et al. Prevalence of cachexia in chronic heart failure and characteristics of body composition and metabolic status. Endocrine 43, 626–634 (2013). https://doi.org/10.1007/s12020-012-9836-3

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  • DOI: https://doi.org/10.1007/s12020-012-9836-3

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