Chronic heart failure and micronutrients

Heart failure (HF) is associated with weight loss, and cachexia is a well-r ecognized complication. Patients have an increased risk of osteoporosis and lose muscle bulk early in the course of the disease. Basal metabolic rate is increased in HF, but general malnutrition may play a part in the develop ment of cachexia, particularly in an elderly population. There is evidence for a possible role for micronutrient deficiency in HF. Selective deficienc y of selenium, calcium and thiamine can directly lead to the HF syndrome. O ther nutrients, particularly vitamins C and E and beta-carotene, are antiox idants and may have a protective effect on the vasculature. Vitamins B-6, B -12 and folate all tend to reduce levels of homocysteine, which is associat ed with increased oxidative stress. Carnitine, co-enzyme Q(10) and creatine supplementation have resulted in improved exercise capacity in patients wi th HF in some studies. In this article, we review the relation between micr onutrients and HF. Chronic HF is characterized by high mortality and morbid ity, and research effort has centered on pharmacological management, with t he successful introduction of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists into routine practice. There is sufficient evid ence to support a large-scale trial of dietary micronutrient supplementatio n in HF. (J Am Coll Cardiol 2001;37:1765-74) (C) 2001 by the American Colle ge of Cardiology.