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LE Magazine Febuary 1998

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Congestive Heart Failure and Cardiomyopathy Update

Based on new evidence,The Foundation has revised its protocol for the treatment of heart muscle energy deficits.

Energy deficiencies at the cellular level cause gradual weakening of the heart muscle until a transplant becomes necessary. These energy deficits often are a cause of congestive heart failure and many forms of cardiomyopathy. Treatment of a weakened heart muscle involves the use of several different therapies known to boost cardiac energy levels and decrease vascular resistance.

image We will discuss the different therapies that are used to treat heart muscle energy deficits, which are clinically diagnosed as congestive heart failure or cardiomyapathy, and then provide a step-by-step approach to their treatment.

Coenzyme Q10 is a naturally occurring substance that has antioxidant and membrane stabilizing properties. The oral administration of coenzyme Q10 in conjunction with standard medical therapy has been reported to increase cardiac output and enhance functional capacity in patients with congestive heart failure. A study evaluated 17 congestive heart failure patients after four months of coenzyme Q10 therapy and found the following results:

Functional class improved 20 percent.
Mean congestive heart failure score improved 27 percent.
Left ventricular ejection fraction improved 34.8 percent.
Cardiac output improved 15.7 percent.
Stroke volume index improved 18.9 percent.
End-diastolic volume area decreased 8.4 percent.
Systolic blood pressure decreased 4.4 percent.



Therapy with coenzyme Q10 was associated with a mean 25.4 percent increase in exercise duration and a 14.3 percent increase in workload. The doctors concluded by stating, "Coenzyme Q10 therapy is associated with significant functional, clinical and hemodynamic improvements within the context of an extremely favorable benefit-to-risk ratio. Coenzyme Q10 enhances cardiac output by exerting a positive inotropic effect on the myocardium as well as mild vasodilatation."

Clinical research and theoretical considerations indicate that supplemental taurine, coenzyme Q10 and L-carnitine, and the minerals magnesium, potassium and chromium, may be of value in the treatment of congestive heart failure. High intake of fish oil can decrease vascular resistance to reduce the energy requirements of the weakened heart muscle. Fish oil also reduces blood viscosity, and may reduce the risk of arrhythmias and arterial blood clots. There appears to be little if any risk in combining these nutrients with conventional drugs.

Magnesium has been shown to be beneficial in improving hemodynamics and in treating arrhythmias. Magnesium toxicity rarely occurs except in patients with kidney dysfunction. In patients with congestive heart failure, total body magnesium is an important predictor of arrhythmias, digitalis toxicity and hemodynamic abnormalities. While magnesium appears to be of value as part of an overall treatment program, some studies have shown that magnesium alone is ineffective in treating congestive heart failure.

Seven patients with idiopathic dilated cardiomyopathy and moderate to severe heart failure were studied at base line after three months of human growth hormone (HGH) therapy, and three months after the discontinuation of HGH. Standard therapy for heart failure was continued throughout the study. When administered at a dose of 14 IU per week, growth hormone doubled the serum concentration of insulin-like growth factor I (IGF-1). Growth hormone improved cardiac output, particularly during exercise, and doubled ventricular mechanical efficiency, despite reductions in myocardial oxygen consumption and energy production. Growth hormone also improved clinical symptoms, exercise capacity, and the patients' quality of life. After growth hormone was discontinued for three months, the improvements in function reversed partially. Those who suffer from cardiac insufficiency diagnosed as cardiomyopathy or congestive heart failure may be helped by taking the following energy-enhancing nutrients:

Advise your physician about everything you are doing so that he or she can adjust your treatment program appropriately. For additional suggestions, refer to the Foundation's Atherosclerosis protocol.

For those who cannot afford growth hormone therapy, 6 to 10 grams a day ofArginineis suggested. There are studies showing thatArgininecan boost cardiac output by itself.

One study reported on the conventional drugs doctors use to treat congestive heart failure. Here is the percentage of frequency: diuretics, 82 percent; angiotensin-converting enzyme inhibitors (such as Zestril or Capoten), 53 percent; nitrates, 49 percent; digoxin, 46 percent; potassium, 40 percent; aspirin, 36 percent; calcium antagonists, 20 percent; warfarin, 17 percent; beta-blockers, 15 percent; andmagnesium, 10 percent.

Diuretic drugs deplete the body of the electrolyte minerals magnesium and potassium. Those taking diuretics are often prescribed potassium and magnesium by their physicians. If your doctor is not prescribing these two critical minerals, ask why.

Angiotension-converting enzyme inhibiting drugs relax the vascular system, thus reducing the workload of the heart. Fish oil also can relax the vascular system.

Digoxin (Lanoxin) improves the strength and efficiency of the heart. Coenzyme Q10, taurine, acetyl-L-carnitine and other nutrients also improve cardiac energy output.

Many popular FDA-approved drugs are classified as inotropic drugs. Inotropic drugs function via several different mechanisms to increase the ability of heart tissue to contract.

However, an analysis of the new literature provides contrasting views on the use of inotropic therapies in the long-term treatment of congestive heart failure. Some studies indicate that inotropic therapies produce a significant temporary boost in cardiac output, but fail to prolong the lives of patients. They may even shorten the lives of some patients. The mechanisms responsible for the limitations of inotropic therapies may be energy depletion and arrhythmia inducement.

The use of coenzyme Q10, carnitine, taurine, fish oils and other nutrients could, in theory, maintain energy levels and inhibit arrhythmias. This could explain the benefits observed when these nutrients are combined with conventional inotropic drugs. Forskolin is considered an inotropic agent. Based on new evidence about inotropic agents, we are no longer recommending forskolin in the treatment of congestive heart failure or cardiomyopathy. We are currently investigating the efficacy of orally administered forskolin to determine its effects in cases of hypertension and glaucoma.

Please review the nutrients you plan to take with the doctor prescribing the medications used to treat your cardiomyopathy and/or congestive heart failure.



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