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TESTOSTERONE - A TONIC FOR THE HEART.
Channer, K.S.
Consultant Cardiologist, Royal Hallamshire Hospital, Sheffield S10
2JF Hon Professor of Cardiovascular Medicine, Sheffield Hallam University.
Dept. of Cardiology, Royal Hallamshire Hospital, Sheffield Teaching
Hospitals NHS Trust, Sheffield, S10 2JF, UK Kevin.Channer@sth.nhs.uk
Chronic heart failure (CHF) is a major health burden, characterized
by the inability of the heart to meet cardiac output requirements,
resulting in shortness of breath, fluid retention and cachexia.
In the vast majority of cases, CHF is a relentlessly progressive
condition with a poor prognosis - worse than many cancers. Follow
up studies show that 50% survival from first presentation with CHF
is only about 5 years (Levy D. et al NEJM 2002; 347: 1397-42). Progression
occurs because of the physiological maladaptations that develop
in CHF resulting in over expression of neurohormones, such as norepinephrine
and angiotensin II, as a result of activation of the sympathetic
nervous system and renin-angiotensin system.
Drug therapies are aimed at interrupting the pathophysiology. Symptom
palliation and extension of life have been demonstrated with drugs
including angiotensin converting enzyme inhibitors, aldosterone
antagonists and beta-blockers alone and in combination (Malkin CJ
& Channer KS EJHF 2005: 7 : 143-8). More recently a second class
of biologically active molecules, cytokines, have been identified,
with the "cytokine hypothesis" stating that these molecules may
be involved in the development and progression of CHF.
Treatment in heart failure is essentially palliative and quality
of life is important. In this presentation I discuss the potential
value of testosterone replacement therapy for men with heart failure
and discuss its role in interrupting the physiological maladaptations
of the condition.
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