Mechanisms of Wasting in Heart Failure

It has been established for centuries that body wasting and changes in body composition play important roles in patients with chronic diseases. This is also true for patients with heart failure (HF).1 For clinicians not actively involved in this area of research, however, it may be difficult to decipher the complex and sometimes confusing terminology used in this context. Cachexia, body wasting, anorexia, sarcopenia, malnutrition, or even the recent addition myopenia—do they essentially all mean the same?2,3 Is loss of fat mass commonly propagated for healthy people or patients with cardiovascular disease also beneficial once HF is present? Or is it at least preferable to muscle loss? No physician would seriously suggest to a patient with malignant cancer to start losing weight, as this is generally thought of as a signum mali ominis. Just the same may be true for HF. Current guidelines4 for coronary artery disease, however, do not distinguish between those who do and those who do not suffer from concomitant HF, and, hence, all these patients are lumped together and provided with guidance that is everything but evidence-based.