Hormone Therapy to Treat Cardiac Remodeling: Is There Any Evidence?

Cardiac remodeling can be defined as a set of molecular, cellular and interstitial cardiac variations, which manifest clinically as changes in heart size, mass, geometry and function in response to certain aggressions. That process has bad prognosis, because it is associated with ventricular dysfunction progression and malignant arrhythmias. Different therapeutic strategies have been assessed to prevent, or at least attenuate, cardiac remodeling.^, Some treatments, such as those using angiotensin-convert-enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, and aldosterone antagonists, have been well established. Other treatments, despite their pathophysiological potential, are still being studied. Of those, hormone therapy stands out, particularly with testosterone, thyroid hormone, and growth hormone (GH).

Testosterone has received great attention in recent years. From the pathophysiological viewpoint, in the presence of ventricular dysfunction, testosterone can modulate the cardiac remodeling process, strengthen skeletal musculature, enhance exercise capacity and reduce inflammatory activity.^, It is worth noting that a significant number of patients with heart failure have reduced testosterone levels. In addition, low testosterone levels in patients with heart failure are an independent risk factor for hospital readmission within 90 days and for mortality. Thus, testosterone supplementation seems an attractive strategy to manage heart failure.

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