Nutrition and Heart Failure: Impact of Drug Therapies and Management Strategies

Abstract

Nutrition impairment commonly occurs in patients with heart failure and affects disease progression. Vitamin and mineral deficiencies are associated with early mortality, particularly in patients classified as cachectic. Guideline-based therapies approved for heart failure, such as loop diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, aldosterone antagonists, and beta-adrenergic blockers, can lead to electrolyte abnormalities and predispose to some vitamin and micronutrient deficits. Clinical trial evidence in support of supplementary vitamin and mineral therapies for heart failure patients is limited with the exception of documented calcium and possibly vitamin D, thiamine, and coenzyme Q10 deficiencies. This area is gaining significant attention, and research is ongoing. The clinician can help minimize morbidity from nutrition impairment through appropriate monitoring and correction of baseline and medication-induced electrolyte imbalances, in addition to vitamin and mineral supplementation when appropriate.

The Dietary Quality of Persons with Heart Failure in NHANES 1999–2006

“…28 Unfortunately, loop diuretics may cause hypocalcemia. 29 Thus, insufficient intake of calcium, flagged by the 2005 Dietary Guidelines for Americans (DGA 2005) as a nutrient of concern for most Americans, 30 is of particular concern among persons with heart failure. The DGA 2005 also named magnesium a nutrient of concern.…”

The older patient with heart failure: high risk for frailty and cognitive impairment

“…With the development of anabolic/catabolic imbalance, muscle wasting and cardiac cachexia, their prognosis worsens [83]. Reduced dietary intake, the HF state and the treatment of HF may result in the reduction of minerals such as potassium, calcium, zinc and magnesium [82,84]. Usually dietary counseling focuses on low-sodium intake with little consideration of other necessary nutrients, and this may further exacerbate the nutritional deficiencies of HF patients.…”

The Dietary Approaches to Stop Hypertension (DASH) Eating Pattern in Special Populations

“…The AHA/American College of Cardiology (AHA/ACC) recommends “moderate sodium restriction” for patients with current or prior symptoms of HF [39]. The American Dietetic Association guideline for sodium in HF patients is < 2 g/day with the rationale of improving clinical symptoms (e.g., edema, fatigue) and quality of life [40]. The DASH diet plus reduced sodium intake lowers BP more than either intervention alone [41].…”