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J Am Coll Cardiol, 2001; 37:1765-1774 © 2001 by the American College of Cardiology Foundation |
a Castle Hill Hospital, University of Hull, Kingston upon Hull, United Kingdom
Manuscript received September 11, 2000; revised manuscript received January 24, 2001, accepted February 6, 2001.
Reprint requests and correspondence: Dr. K. Witte, Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, United Kingdom
klauswitte{at}Hotmail.com
Heart failure (HF) is associated with weight loss, and cachexia is a well-recognized 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 development of cachexia, particularly in an elderly population. There is evidence for a possible role for micronutrient deficiency in HF. Selective deficiency of selenium, calcium and thiamine can directly lead to the HF syndrome. Other nutrients, particularly vitamins C and E and beta-carotene, are antioxidants and may have a protective effect on the vasculature. Vitamins B6, B12 and folate all tend to reduce levels of homocysteine, which is associated with increased oxidative stress. Carnitine, co-enzyme Q10 and creatine supplementation have resulted in improved exercise capacity in patients with HF in some studies. In this article, we review the relation between micronutrients and HF. Chronic HF is characterized by high mortality and morbidity, and research effort has centered on pharmacological management, with the successful introduction of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists into routine practice. There is sufficient evidence to support a large-scale trial of dietary micronutrient supplementation in HF.
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