In the "hypothesis generating" study, ursodeoxycholic acid (UDCA) delivered significant improvements in peak post ischemic blood flow in the arm, a trend for improvement in peak post ischemic blood flow in the leg, but failed to show benefits in exercise capacity and several inflammatory markers. Despite such conflicting data, ESC spokespersons believe that further exploration of UCDA is now justified in larger populations of heart failure patients.
"Although the study failed on two out of three counts , the observed improvements in post ischemic arm and leg blood flow make it highly unlikely such findings would have occurred purely by chance," says Professor Kenneth Dickstein, an ESC spokesperson. "The results are enough to pique real interest and suggest the approach has the potential to offer another string to our bow for improving heart failure symptoms."
It is also noteworthy, adds Dickstein from the University of Bergen (Stavanger University Hospital, Norway), that JACC felt the study to be of sufficient merit to commission an editorial².
Any future studies undertaken, says Dickstein, will need to involve larger cohorts of patients. "One big question for me is whether four weeks of treatment is sufficient to produce significant effects. This begs the question of whether higher doses and longer durations of treatment might have produced clearer cut answers," he adds.Recent registries showing a 5 to 8% annual mortality for chronic heart failure patients underline the urgent need for new heart failure treatments in addition to the standard ACE inhibitors, ARBs, beta blockers, aldosterone blockers and devices (implantable cardioverter defibrillators and cardiac resynchronisation therapy). "Since UDCA doesn't involve any of the known mechanisms adding this approach to the standard treatments might result in incremental gains," says Maggioni.
2. J.M. McCabe, J.R. Teerlink, et al. Bile Salts for the Treatment of Heart Failure: Out on a limb for a gut feeling? Ibid, pp593-4.
The European Society of Cardiology (ESC) represents more than 71,200 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.ESC Press Office:
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