Can tesamorelin (growth hormone-releasing factor) worsen cardiomyopathy?

Tesamorelin and Cardiomyopathy: Safety Considerations

Tesamorelin does not have evidence of worsening cardiomyopathy, but caution is warranted in patients with pre-existing cardiac disease due to its growth hormone-stimulating effects.

Mechanism and Cardiac Considerations

Tesamorelin is a growth hormone-releasing factor (GHRF) analogue that stimulates the synthesis and release of endogenous growth hormone. When evaluating its potential impact on cardiomyopathy:

• Growth hormone has known effects on cardiac tissue, including potential myocardial remodeling
• No direct evidence in guidelines shows tesamorelin worsens existing cardiomyopathy
• The medication is primarily used for HIV-associated lipodystrophy 1, 2

Risk Assessment for Different Cardiomyopathies

Hypertrophic Cardiomyopathy (HCM)

• Theoretical concern: Growth hormone stimulation could potentially exacerbate myocardial hypertrophy in HCM patients
• HCM patients should avoid medications that could promote further hypertrophy 3
• The 2020 AHA/ACC guidelines for HCM recommend monitoring and treating comorbidities that can worsen HCM severity 3

Dilated Cardiomyopathy

• No specific evidence that tesamorelin worsens dilated cardiomyopathy
• Patients with reduced ejection fraction (<50%) require careful monitoring of medications that might affect cardiac function 3

Clinical Decision Algorithm

1. Assess baseline cardiac function:

   • Evaluate LVEF and presence/type of cardiomyopathy
   • Consider cardiac biomarkers (troponin, BNP) before initiating therapy 4

2. Risk stratification:

   • High risk: Patients with HCM, especially with LVEF <50%
   • Moderate risk: Stable cardiomyopathy with preserved LVEF
   • Low risk: No evidence of cardiomyopathy

3. Monitoring recommendations:

   • Baseline cardiac evaluation before starting treatment
   • Regular follow-up with echocardiography during treatment
   • Monitor for symptoms of worsening heart failure

Special Considerations

Exercise and Activity with Cardiomyopathy

• Patients with cardiomyopathy on tesamorelin should follow appropriate exercise guidelines
• For HCM patients, mild to moderate-intensity recreational exercise is beneficial 3
• High-intensity exercise should be avoided in HCM patients as it may increase risk of sudden cardiac death 3

Medication Interactions

• Avoid combining tesamorelin with other medications that may worsen cardiomyopathy
• In HCM patients with outflow tract obstruction, avoid arterial and venous dilators, including nitrates and phosphodiesterase inhibitors 3

Conclusion and Recommendations

While there is no direct evidence that tesamorelin worsens cardiomyopathy, caution is warranted due to its growth hormone-stimulating effects. The decision to use tesamorelin in patients with cardiomyopathy should be based on:

• Type and severity of cardiomyopathy
• Overall benefit-risk assessment
• Availability of alternative treatments
• Implementation of appropriate cardiac monitoring

For patients with HIV-associated lipodystrophy who also have cardiomyopathy, the benefits of tesamorelin in reducing visceral adipose tissue 5, 6 must be carefully weighed against the theoretical cardiac risks.