Dominic Stone
Heart disease can lead to muscle wasting, which is known as cachexia or sarcopenia. Cachexia is a type of malnutrition and muscle loss that affects people with severe heart failure, whereas sarcopenia is considered an age-dependent syndrome associated with muscle dysfunction and impaired physical performance. Muscle wasting is a common feature in patients with heart failure, affecting their quality of life and exercise capacity. It is also an independent predictor of mortality in these patients. While there are some treatment options, such as resistance exercise and nutritional support, understanding the underlying causes of muscle wasting in heart disease is crucial for developing new treatments to improve patients' overall well-being.
| Characteristics | Values |
|---|---|
| Prevalence | Affects approximately 20% of ambulatory patients with heart failure |
| Severity | An independent predictor of death in ambulatory patients with heart failure |
| Risk factors | Age, previous heart attacks, coronary artery disease, cardiomyopathy, high blood pressure, arrhythmias, valve disease, congenital heart disease, atrial fibrillation, diabetes mellitus, chronic obstructive pulmonary disease, sleep-disordered breathing, iron deficiency, chronic kidney disease, malnutrition, inflammatory cytokines, anorexia, obesity, genetic factors |
| Symptoms | Reduced exercise capacity, breathlessness, fatigue, loss of appetite, weight loss, frailty, weakness, falls, injuries, confusion, memory issues, swelling, fluid retention, shortness of breath, persistent cough, rapid or irregular heartbeat, sudden weight gain |
| Diagnosis | Blood tests, electrocardiogram (ECG/EKG), echocardiogram, chest x-ray, DEXA scan, computed tomography (CT), magnetic resonance imaging (MRI), cardiopulmonary exercise testing, right heart catheterization |
| Treatment | Heart failure medications (ACE inhibitors, beta-blockers, SGLT2 inhibitors), device therapy (ICDs, CRTs), resistance exercise, specialized nutritional support, acetylated ghrelin treatment, small molecule inhibitors of the E3‐ligase muscle ring finger 1, microRNA interventions |
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What You'll Learn
- Cardiac cachexia: a type of malnutrition and muscle loss
- MicroRNAs: small molecules that control gene expression
- Muscle wasting as a survival predictor: associated with higher mortality
- Cachexia vs. sarcopenia: differences in muscle wasting types
- Treatment options: medication, resistance exercise, and nutritional support
Cardiac cachexia: a type of malnutrition and muscle loss
Cardiac cachexia is a condition characterised by significant weight loss and muscle wasting in individuals with advanced heart failure. It is a form of malnutrition, resulting in a loss of fat, muscle mass, and bone mineral density. The condition affects around 10-39% of people with chronic heart failure, contributing to frailty, weakness, and reduced quality of life.
To be diagnosed with cardiac cachexia, an individual must have lost at least 5% of their body weight over the previous year, excluding fluid loss. Additionally, at least three of the following criteria must be present: decreased muscle strength, fatigue, loss of appetite, low fat-free mass index, increased inflammation, or low serum albumin levels. Cardiac cachexia can lead to sarcopenia, a condition characterised by muscle wasting, which further exacerbates the patient's weakness and frailty.
The causes of cardiac cachexia are multifaceted and not fully understood. They include hormonal changes, neurohormonal abnormalities, metabolic hormone imbalances, gastrointestinal abnormalities, and inadequate protein intake. The condition is associated with a high mortality risk, with a reported increase in mortality rates of up to 50% within 18 months of diagnosis.
While there is no cure for cardiac cachexia, treatments aim to alleviate symptoms and improve quality of life. These treatments include medications such as beta-blockers, anabolic steroids, and human growth hormones. Dietary supplements, such as vitamin C, vitamin E, protein supplements, and omega-3 fatty acids, are also recommended. In some cases, a left ventricular assist device (LVAD) may be attached to the heart to help pump blood to the aorta and the rest of the body.
Cardiac cachexia is a severe complication of advanced heart failure, leading to significant weight loss, muscle wasting, and increased frailty. Its complex pathophysiology makes it challenging to manage clinically, and it poses a significant risk to the patient's health and survival.
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MicroRNAs: small molecules that control gene expression
Muscle wasting is a common feature in patients with heart failure, affecting around 20% of ambulatory patients, with even higher values during acute hospitalisation. Heart failure, which can be caused by coronary heart disease, heart attacks, cardiomyopathy, and high blood pressure, leads to reduced exercise capacity and a diminished quality of life.
Muscle wasting, also known as cachexia, is a type of malnutrition and muscle loss that occurs in people with severe heart failure. Cachexia is characterised by unintentional weight loss, loss of muscle strength or mass, fatigue, and a reduced ability to complete daily activities. Cardiac cachexia can affect about 10-39% of people with chronic heart failure, and it can lead to sarcopenia, or the loss of muscle mass, and sometimes scarring of the heart muscle. Sarcopenia is largely considered an age-dependent syndrome, affecting 5-13% of people aged 60-70 and up to 50% of octogenarians. It is associated with muscle dysfunction and impaired physical performance, which can be exacerbated by chronic diseases.
MicroRNAs are small molecules that control gene expression and have been identified as potential targets for intervention in cardiac cachexia. Certain microRNAs make muscle cells more sensitive to myostatin, a protein that causes muscle breakdown. Some individuals have specific patterns of microRNAs that increase their susceptibility to muscle wasting due to ineffective muscle repair.
Research by Dr Paul Kemp and his team at Imperial College London has focused on these microRNAs, aiming to understand the causes of muscle weakness and develop new treatments to restore muscle mass and improve patients' quality of life.
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Muscle wasting as a survival predictor: associated with higher mortality
Muscle wasting is a common feature in patients with heart failure, affecting around 20% of ambulatory patients. It is associated with reduced exercise capacity, muscle strength, and quality of life. It also makes it difficult to perform everyday tasks or exercise. Muscle wasting is an independent predictor of death in ambulatory patients with heart failure.
Several studies have been conducted to examine the association between muscle wasting and mortality risk. One study found that muscle wasting was associated with a 36% increased risk of all-cause mortality in the general population. The risk of all-cause mortality related to muscle wasting was higher in the elderly than in younger populations. Another study found that muscle wasting, as assessed by DXA scanning, might be a more sensitive predictor of mortality.
Tsuji et al. examined psoas muscle mass in patients undergoing left ventricular assist device implantation. They found that perioperative muscle wasting, as extrapolated from the psoas measurement approach, was associated with higher mortality in their patient cohort. Similarly, a study by Fülster et al. found that muscle wasting was an independent predictor of death in patients with chronic heart failure.
Clinical trials are needed to identify treatment approaches to this co-morbidity. Understanding the causes of muscle wasting may help develop new treatments to restore muscle mass and improve quality of life.
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Cachexia vs. sarcopenia: differences in muscle wasting types
Muscle wasting is a common feature in patients with heart failure, affecting approximately 20% of ambulatory patients. It can make it difficult to perform everyday tasks or exercise. Heart failure itself is commonly caused by coronary heart disease, heart attacks, cardiomyopathy, and high blood pressure.
Muscle wasting conditions, in general, have been gaining attention for their role in metabolism and health promotion. Sarcopenia and cachexia are two of the most prominent muscle-wasting conditions. They are usually the result of unique underlying causes and are distinct from starvation. Sarcopenia is defined as the loss of muscle mass and function associated with aging. Cachexia is defined as weight loss due to underlying illness. Cachexia is also associated with skeletal muscle wasting, fat tissue loss, and reduced bone mineral density.
Zinc and vitamin D3 deficiencies are associated with both sarcopenia and cachexia. Zinc regulates various cellular processes in the body, including muscle protein synthesis. Zinc deprivation promotes the deterioration of slow muscle fibres, which may contribute to more severe forms of sarcopenia and cachexia. Vitamin D3 is involved in regulating muscle tissue and function, specifically through enhancing muscle contraction and strength. Low levels of vitamin D3 have been associated with promoting muscle atrophy, particularly in aged individuals.
The clinical consequences of bed rest may mimic those of cachexia, including rapid loss of muscle, insulin resistance, and weakness. Nutritional supplementation alone may not prevent muscle loss secondary to cachexia, but in combination with an anabolic agent, it may slow or prevent muscle loss.
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Treatment options: medication, resistance exercise, and nutritional support
Muscle wasting is an unfortunate consequence of severe heart failure, making it difficult to perform everyday tasks and exercise. While there is ongoing research into the causes of muscle wasting, there are currently no established treatments. However, some interventions can help manage the condition and improve quality of life. These include medication, resistance exercise, and nutritional support.
Medication
Medications such as enzyme replacement therapy can be used to treat muscle wasting. For example, Dr Paul Kemp and his team at Imperial College London are studying the use of microRNAs, which control gene expression, to target the proteins that cause muscle breakdown.
Resistance Exercise
Resistance exercise can be an effective way to counteract muscle wasting. Isotonic exercises, for example, can help target weakness and improve muscle mass regulation.
Nutritional Support
Nutritional support is also crucial in managing muscle wasting. Malnutrition is a common complication in patients with advanced heart failure, and adequate nutritional care can play a positive role in preventing and treating muscle wasting. Nutritional interventions such as leucine supplementation have been suggested as a treatment for muscle wasting.
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Frequently asked questions
Yes, muscle wasting is a common feature in patients with heart failure.
Muscle wasting, also known as sarcopenia, is the loss of skeletal muscle mass and function. It can be caused by malnutrition, inflammation, or a combination of both.
Muscle wasting affects approximately 20% of ambulatory patients with heart failure, with even higher values during acute hospitalisation.
Muscle wasting can lead to reduced quality of life, low exercise capacity, and increased frailty, disability, and mortality.
Currently, resistance exercise is the main intervention for muscle wasting. However, specialised nutritional support and certain medications may also aid in preventing and treating muscle wasting.
