Micronutrient Deficiencies

Abstract

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.

Allopurinol Acutely Increases Adenosine Triphospate Energy Delivery in Failing Human Hearts

“…Metabolic strategies to treat heart disease were first proposed more than 50 years ago(35;36) and the literature has been recently reviewed(37;38). Another area where modest metabolic improvements may be clinically relevant in HF relates to the observation that fatty acid oxidation is increased in HF but is a less efficient carbon source than glucose, consuming 11–12% more oxygen per molecule of ATP synthesized(37;39).…”

Effect of <smlcap>L</smlcap>-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial

“…Soukoulis et al [28] and Marcovina et al [7] also reported that supplementation with L -carnitine improves the echocardiographic parameters due to better efficiency of mitochondrial function of cardiomyocytes. L -carnitine supplementation adjuvant treatment of HF showed an improvement in echocardiographic parameters [29,30], left ventricular dilatation attenuation [25] and 27% reduction of all cardiovascular causes of death [31].…”

<i>L</i>-Carnitine Treatment in Patients with Mild Diastolic Heart Failure Is Associated with Improvement in Diastolic Function and Symptoms

“…It has been shown to correct secondary muscle L -carnitine deficiency in patients with peripheral vascular disease, significantly improving walking capacity [25]. There have been several studies evaluating L -carnitine treatment in cardiovascular diseases and heart failure [26]. A multicenter trial CEDIM ( L -carnitine Ecocardiografia Digitalizzata Infarto Miocardico) showed a positive effect of L -carnitine on cardiac remodeling after myocardial infarction [27].…”