Growth Hormone Therapy in Heart Failure: Where Are We Now?

Catherine Demers, MD, MSc, Robert S. McKelvie, MD, PhD

Disclosures

CHF. 2003;9(2) 

In This Article

Abstract and Introduction

Despite improvement in survival with angiotensin-converting enzyme inhibitors and blockers, clinical events for patients with heart failure remain elevated. New therapies for heart failure are needed to improve functional capacity, quality of life, and prognosis. Growth hormone exerts direct and indirect effects on cardiac structure and function. Experimental models of heart failure and small studies have demonstrated significant improvements in cardiac function, hemodynamic parameters, functional capacity, and quality of life. Despite the lack of benefit demonstrated in small, short-term, randomized clinical trials, further studies are needed to assess the potential role of this adjuvant therapy in heart failure patients.

Angiotensin-converting enzyme inhibitors and blockers have significantly decreased mortality and morbidity in heart failure (HF) patients and are considered the cornerstone of HF treatment.[1,2,3,4,5,6] Although mortality has decreased, clinical event rates remain at an unacceptable level. Potential novel therapies need to be investigated to determine if they may be of benefit to further improve quality of life, functional capacity, and prognosis in HF patients. HF is characterized by cell loss, decreased myocardial contractility, left ventricular dilatation, and increased systolic wall stress. Growth factors, such as growth hormone (GH) and insulin growth factor I (IGF-I), may potentially affect left ventricular remodeling by increasing myocardial cell hypertrophy, improving myocardial contractility, increasing cardiac output, providing additional peripheral vasodilatation, and decreasing afterload.[7,8] In this paper, we will review the role of GH in cardiac function, data on the cardiovascular effects of GH in patients with GH deficiency and excess, the effects of GH in experimental animal HF models, nonrandomized clinical studies, and randomized, controlled clinical trials of HF patients in terms of cardiac function, hemodynamic parameters, exercise performance, and quality of life.

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