AT1-receptor blockers

finding of elevated leptin levels in cardiac failure patients stage NYHA II or III is supported by Filippatos et al. and others. From their data, however, it appears that leptin levels tend to decrease in cachectic patients with more advanced stages of the disease, which has only recently been confirmed by others. This does not necessarily contradict our observations. The patients reported in our study presented with normal or slightly elevated body mass index and did not reach the stage of cachexia (BMI SEM: 25·8 1·17 kg . m ). The leptin levels indicated (5·31 ng . ml 1 (4·17 to 10·81) vs 2·19 ng . ml 1 (1·95 to 3·05); median (interquartile range)) are normalized for the BMI, which should be considered when comparing leptin levels. A possible explanation for increased leptin levels in less severely affected patients and decreased levels in cachectic end stage heart failure patients may be the predominant decline of muscle mass in milder degrees of the disease, with subsequent reduction of the lean/fat ratio, which is supposed to be responsible for increased leptin production. The further loss of body weight in cachectic patients with advanced disease is due to an additional decline in adipose tissue mass and may thus be associated with a decrease in leptin levels, as has been recently suggested. Whether leptin is implicated in the pathogenic process of the disease or more likely is affected as part of the several components deranged in the disorder of cardiac failure needs to be further clarified.