title: The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure.
abstract: OBJECTIVE
  Chronic heart failure (CHF) is a common and leading cause of death in industrialized countries. The potential benefits of micronutrient supplementation in CHF are extensive. Therefore, we examined the influence of long-term multiple micronutrient supplementation on left ventricular (LV) function, levels of pro-inflammatory cytokines, and quality-of-life (QoL) in elderly patients with CHF.
  
  
  RESULTS
  Thirty CHF patients [age 75.4 (0.7), mean (SEM), LV ejection fraction (LVEF) < or =35%] were randomized to receive capsules containing a combination of high-dose micronutrients (calcium, magnesium, zinc, copper, selenium, vitamin A, thiamine, riboflavin, vitamin B(6), folate, vitamin B(12), vitamin C, vitamin E, vitamin D, and Coenzyme Q10) or placebo for 9 months in a double-blind fashion. All subjects were on stable optimal medical therapy for at least 3 months before enrolment. At randomization and at study end, tumour necrosis factor-alpha and its soluble receptors TNFR-1 and TNFR-2 were measured and six-minute walk test and QoL were assessed. Cardiac magnetic resonance scanning was performed to evaluate cardiac dimensions and LVEF. Two patients died during follow-up. The remaining patients (14 randomized to placebo and 14 to micronutrients) were well matched for LV function, symptoms, and exercise capacity. At the end of the follow-up period, LV volumes were reduced in the intervention group with no change in the placebo group [-13.1 (17.1)% vs. +3.8 (10.0)%; P<0.05]. LVEF increased by 5.3+/-1.4% in the intervention group and was unchanged in the placebo group (P<0.05). Patients taking micronutrients also had a significant improvement in QoL score between enrolment and study end [+9.5 (1.6)%; P<0.05], whereas those taking placebo had a slight deterioration [-1.1 (0.8)%; P=0.12]. Six-minute walk test and inflammatory cytokine levels remained unchanged in both groups.
  
  
  CONCLUSIONS
  Long-term multiple micronutrient supplementation can improve LV volumes and LVEF and QoL scores in elderly patients with heart failure due to LV systolic dysfunction.
authors.affiliation: Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, UK. klauswitte@hotmail.com
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Anita C
authors.initials: AC
authors.lastname: Parker
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Hans-Dieter
authors.initials: HD
authors.lastname: Volk
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D006333:Heart Failure / Q000178:diet therapy*; D006801:Humans; D020714:Maximum Tolerated Dose; D018977:Micronutrients / Q000008:administration & dosage*; D011788:Quality of Life; D018121:Receptors, Cytokine / Q000378:metabolism; D018487:Ventricular Dysfunction, Left / Q000178:diet therapy*
chemical_list: D016207:Cytokines; D018977:Micronutrients; D018121:Receptors, Cytokine