It sounds strange, but the treatment of caridac  failure and cachexia is currently also explored via prescribing beta-blockers. ^[1] This seems to be a therapeutic inroad not only for cachexia related to cardiac failure.

Already in the last century internists have experimemented prescribing beta-blockers such as propranolol for cachexia related to cancer. Propranolol seemed in that indication to correct the autonomic nervous system dysfunction responsible for the elevated metabolism in elderly cancer patients, leading to cachexia. ^[2]  The cachexia and loss of weight in cancer patients is by some authors explained via the increased beta(1) and beta(2)-adrenoceptor activity, in part secondary to elevated cardiovascular activity compensating for anaemia, and loss of cardiac contractility. This argumentation supports the use the use of beta-blockers in the indication cardiac waisting.

In cardiac cachexia beta-blockers and beta-atagonistic drugs are mentioned side to side in recent reviews. Here a quote from German cardiologists :

Other drug classes of interest comprise angiotensin-converting enzyme inhibitors, beta-blockers, anabolic steroids, beta-adrenergic agonists, anti-inflammatory substances, statins, thalidomide, proteasome inhibitors, and pentoxifylline.

This is more than a German affair, as we can see the same interest in beta-blocking agents for instant in recent French review articles. ^[3]

A pilot trial published in 2006 underscored the potential benefit of prescibing beta-blockers in suffering from heart failure, focusing on body mass. In a prospective trial 41 non-cachectic ambulatory heart failure patients were treated with beta blockers for at least 6 months. Total body fat mass and total body fat content increaed during this treatment. ^[4]

Earlier cardiologists from West Haven (USA) treated cardiac cachexia in a pilot trial during 6 month with two different beta-blockers with clear therapeutic results. ^[1]

Taken together there seems to be sufficient science behind the idea to treat cardiac cachexia with beta-blocking agents, and various simple POP studies supported the clinical relevance of this approach. However, no randomised clinical studies of sufficient power have been published so far.

Auteurs: prof.dr. Jan M. Keppel Hesselink, MD, PhD; update september 2009

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