© 2001 European Society of Cardiology
The effects of enalapril-digoxin-diuretic combination therapy on nutritional and anthropometric indices in chronic congestive heart failure: preliminary findings in cardiac cachexia
Department of Medicine, Clinical Pharmacology and Cardiology Units, Faculty of Clinical Sciences, Obafemi Awolowo University Ile-Ife, Nigeria
* Corresponding author. Center of Cardiovascular Diseases, COPHS, Texas Southern University, 3100 Cleburne Avenue, Houston, TX 77004, USA. Tel.: +1-713-313-1891; fax: +1-713-313-4219 E-mail address: adeajayi{at}aol.com (A.A. Leslie Ajayi).
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Abstract |
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Background: Body wasting is a clinical feature of a variety of chronic illnesses including congestive heart failure. The wasting associated with chronic congestive heart failure (cardiac cachexia) has recently been shown to portend a worse prognosis, and it is an independent predictor of mortality. The mechanisms underlying cardiac cachexia are multi-factorial, including metabolic, nutritional, neuroendocrine and immunological aberrations. There is, however, no direct evidence that current medical treatment reverses cachexia in chronic heart failure.
Methods: The effect of enalapril, digoxin and frusemide combination on clinical, biochemical and anthropometric indices were determined in eight cachectic Nigerians with chronic congestive heart failure [body mass index (BMI) 20.80 ± 2.7 kg/m2, left ventricular ejection fraction 29 ± 4% and LV mass index 161 + 37 g/m2] at baseline, and again after 3 and 6 months of therapy. Ten age- and sex-matched healthy volunteers whose anthropometric data were concurrently measured served as controls.
Results: The anthropometric and clinical measurements were significantly (P < 0.001) reduced in heart failure compared to the healthy controls. Congestive hepatomegaly significantly regressed from 161 ± 20 mm to 123 ± 13 mm after 6 months therapy (P < 0.001 ANOVA). There was a significant increase in the sum of four skin fold thickness from 27.6 ± 3.3 mm to 30.1 ± 3.9 mm at 6 months (P < 0.001 ANOVA) 95% confidence intervals for the difference being 1.42 to 3.4 mm. There was a significant increase in the mid-upper arm circumference (P < 0.001 ANOVA) with a 95% confidence interval of 0.87 – 2.1 cm, and a similar trend for increased mid-thigh circumference (95% confidence limits 0.93 – 5.30 cm) was apparent. Plasma albumin and sodium increased significantly (P < 0.05) from 30.1 ± 3.8 g/l and 136 ± 5.9 mmol/l to 32.9 ± 2.5 g/l and 139 ± 3.9 mmol/l, respectively. There was a positive and significant correlation between the treatment induced increases in plasma albumin and the increase in mid-upper arm circumference (y = 0.25x + 0.8, r = 0.76, P = 0.03 ANOVA) but not with the change in skin fold thickness.
Conclusion: The preliminary results demonstrate increased subcutaneous fat (increased skin fold thickness), greater muscle bulk (increased mid-upper arm and thigh circumferences) together with a significant elevation in plasma albumin and the hematocrit, which reflect the anabolic state in patients treated with ACE inhibitor–digoxin–diuretic with congestive heart failure.
Key Words: Congestive heart failure • Cachexia • Hypertension • Anthropometry • Enalapril • Plasma albumin
Received July 18, 2000; Revised October 23, 2000; Accepted November 30, 2000
1 Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA.
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