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Long term nutrient supplementation improves heart function and quality of life in chronic heart failure patients
A report published in the November 2005 issue of European Heart Journal documented the findings of British and German researchers that supplementation with a formula containing a number of nutrients improved heart function and quality of life in older individuals with chronic heart failure due to left ventricular systolic dysfunction.
The left and right ventricles of the heart are its pumping stations. Systolic dysfunction of the left ventricle means that not enough blood is being ejected from the heart into the arteries.
The authors introduce their subject by writing, “Recently, there have been moves to tighten control of micronutrient sales directly to the public . . . it seems very important to establish whether micronutrient supplements are an expensive placebo or effective therapy. A major problem with existing supplementation studies is that they tend to focus on just one micronutrient that, owing to complex metabolic pathways, may be ineffective or even exacerbate deficiencies in other pathways. Also, existing studies have not focused on elderly patients with heart failure, those at greatest risk of deficiency and its adverse consequences.”
Thirty-two patients over the age of 70 with stable chronic heart failure confirmed on echocardiography were admitted to the current study. Participants were randomized to receive placebo capsules or capsules that contained 250 milligrams calcium, 150 milligrams magnesium, 15 milligrams zinc, 1.2 milligrams copper, 50 micrograms selenium, 800 micrograms vitamin A, 200 milligrams thiamin, 2 milligrams riboflavin, 200 milligrams vitamin B6, 5 milligrams folate, 200 micrograms vitamin B12, 500 milligrams vitamin C, 400 milligrams vitamin E, 10 micrograms vitamin D, and 150 milligrams coenzyme Q10. Subjects completed quality of life questionnaires, had blood samples drawn for analysis, and underwent cardiac magnetic resonance to assess cardiac function at the study’s onset and conclusion. Participants were followed for an average of 295 days.
At the end of the study, left ventricular end-diastolic and end-systolic volumes had declined, and ejection fraction improved in those who received the nutritional supplements compared to the placebo group. Those who received the nutrients also reported improved quality of life, while those who received the placebo reported a decrease. The major quality of life differences between the two groups were in exertional breathlessness, sleep quality, daytime concentration, and overall quality.
In their discussion of the findings, the authors write that one potential mechanism of nutritional supplementation is the reduction of oxidative stress, markers of which are elevated in heart failure patients. These patients have been found to have low levels of myocardial coenzyme Q10, an antioxidant which, when reduced, has been associated with increase heart failure mortality. They observe that “the reduction of synthesis of coenzyme Q10 by statins seems to be of sufficient concern that regulatory authorities required plasma coenzyme Q10 measurements in a substantial proportion of patient in a large mortality trial of rosuvastatin in heart failure.” The authors additionally note the benefits that have been found on cardiac function resulting from the antioxidant nutrients vitamins C and E, magnesium, selenium and zinc. Selenium can also cause vascular smooth muscle relaxation and vitamin C and vitamin E improve endothelial-dependent vasodilation.
The conclusion of the study is that long term multiple micronutrient supplementation improves heart function and quality of life scores in older heart failure patients. It was noted that the improvements reported in quality of life may be the result of improved cardiac function.
Congestive heart failure and cardiomyopathy
Congestive heart failure (CHF) occurs when the heart is unable to pump blood throughout the body (but not all patients with heart failure have congestion). There are two categories of congestive heart failure: systolic and diastolic. In the systolic type of the disease, blood coming into the heart from the lungs may be regurgitated so that fluid accumulates in the lungs (pulmonary congestion). In the diastolic type, the heart muscle becomes stiff and cannot relax, leading to an accumulation of fluid in the feet, ankles, legs, and abdomen.
Coenzyme Q10 is a naturally occurring substance that may have considerable value as an adjunct therapy for the treatment of CHF. Clinical studies indicate that coenzyme Q10 can improve the quality of life, allow for a reduction of other pharmacological agents, and decrease the incidence of cardiac complications from CHF. In those patients who receive little benefit from conventional medications, coenzyme Q10 may be a highly effective form of therapy.
Because low magnesium levels are associated with frequent arrhythmias and higher mortality in patients with CHF, patients may benefit from magnesium therapy, which improves hemodynamic function and controls arrhythmias. There is little clinical evidence that magnesium therapy alone will provide substantial improvement in the overall condition of patients with CHF. However, in a recent study at the Arizona Heart Institute, patients with CHF who received oral magnesium oxide showed significant improvement in heart rate, mean arterial pressure, and exercise tolerance.
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