Quarterly Focus Issue: Heart Failure
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Micronutrient Deficiencies: An Unmet Need in Heart Failure

https://doi.org/10.1016/j.jacc.2009.08.012Get rights and content
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Heart failure (HF) is a common, disabling, and costly disease. Despite major advances in medical therapy, morbidity and mortality remain high, in part because current pharmacological regimens may not fully address some unique requirements of the heart for energy. The heart requires a continuous supply of energy-providing substrates and amino acids in order to maintain its function. In HF, defects in substrate metabolism and cardiac energy and substrate utilization may contribute to contractile dysfunction. HF is often accompanied by a deficiency in key micronutrients required for unimpeded energy transfer. Correcting these deficits has been proposed as a method to limit or even reverse the progressive myocyte dysfunction and/or necrosis in HF. This review summarizes the existing HF literature with respect to supplementation trials of key micronutrients involved in cardiac metabolism: coenzyme Q10, l-carnitine, thiamine, and amino acids, including taurine. Studies using a broader approach to supplementation are also considered. Although some of the results are promising, none are conclusive. There is a need for a prospective trial to examine the effects of micronutrient supplementation on morbidity and mortality in patients with HF.

Key Words

heart failure
nutrition
energy
micronutrients
metabolism

Abbreviations and Acronyms

ATP
adenosine triphosphate
CoQ10
coenzyme Q10
EF
ejection fraction
HF
heart failure
LV
left ventricle/ventricular
LVEDV
left ventricular end-diastolic volume
LVESV
left ventricular end-systolic volume
MRI
magnetic resonance imaging
NYHA
New York Heart Association

Cited by (0)

Dr. Sole has a share in patents on a nutritional supplement for heart failure (containing any effective combination of coenzyme Q10, l-carnitine or its derivatives, and taurine) issued by the U.S., Canada, and most Western European countries. He has licensed a supplement in Canada to Seaford Pharmaceuticals. Dr. Anker receives research grants and honoraria for speaking and consultancy from Fresenius (Germany)as well as honoraria for consultancy from Professional Dietetics (Italy). Dr. Cleland has a consultancy with NUMICO (recently taken over by DANONE). Dr. Fonarow receives research funding from the National Heart, Lung, and Blood Institute, GlaxoSmithKline, and Pfizer, and is a consultant for or receives honoraria from GlaxoSmithKline, Debiopharm, Novartis, Merck, and Scios. Dr. Taegtmeyer receives research funding from the National Heart, Lung, and Blood Instituteand the American Heart Association. Dr. Gheorghiade performs consultant work with Otsuka, Solvay Pharma, Novartis, Bayer, Sigma-Tau, Debiopharm, Medtronic, Merck, Astellas Pharma, Cytokinetics, Corthera, PeriCor Therapeutics, GlaxoSmithKline, Johnson & Johnson, Abbott, Errekappa Terapeutici, PDL: BioPharma, AstraZeneca, and Sanofi-Aventis.