Vitamins in Heart Failure: Friend or Enemy?
BACKGROUND
The failing heart is characterized by a depleted metabolic energy reserve and the upregulation of several molecular mechanisms leading to cardiac hypertrophy, inflammation, fibrosis, angiogenesis, and apoptosis. Dietary or non-dietary supplementation of vitamins could potentially benefit energy balance.


OBJECTIVE
The objective of the present study was to evaluate all available information on vitamins supplementation in patients with chronic HF for possible beneficial effect on metabolic, inotropic, chronotropic and hemodynamic indices.


METHODS
We searched MEDLINE via Pubmed by using the following terms: "chronic heart failure" OR "cardiomyopathy" AND "vitamins", "vitamin A", "B complex vitamins", "vitamin C", "ascorbic acid", "vitamin D", "retinol", "vitamin E", "thiamine", "riboflavin", "niacin", "pyridoxine", "cobalamin", "folate", "pantothenic acid", "biotin", "tocopherol" and combinations of them.


RESULTS
Data regarding supplementation of micronutrients in HF for most vitamins were sparse, and the inference about cardiovascular outcomes was obscured by the heterogeneity of studies, high inherent morbidity, and mortality of this group of high-risk patients, limited sample sizes in certain studies, unclear design and lack of head to head comparisons. Most vitamins in human trials failed to offer survival, or robust beneficial effect. Mostly indirect favorable evidence is derived from patients with deficiencies of certain micronutrients rather than their ad hoc supplementation.


CONCLUSIONS
While vitamins and micronutrients are promising compounds for optimizing myocardial metabolism and homeostasis in HF, additional randomized clinical trials of larger scale are warranted to demonstrate the benefits of their supplementation in this high risk group of patients.
First Department of Cardiology, 'Hippokration' Hospital, 114, Vas.Sofias Street, PC 11528, Athens. Greece.
George
G
Georgiopoulos
First Department of Cardiology, 'Hippokration' Hospital, 114, Vas.Sofias Street, PC 11528, Athens. Greece.
Christina
C
Chrysohoou
First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens. Greece.
Georgia
G
Vogiatzi
First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens. Greece.
Nikolaos
N
Magkas
First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens. Greece.
Ippokratis
I
Bournelis
Department of Internal Medicine, University Hospital Zurich, Zurich. Switzerland.
Sofia
S
Bampali
Laboratory Medicine, Cliniques Universitaires Saint Luc, Brussels Area. Belgium.
Damien
D
Gruson
First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens. Greece.
Dimitris
D
Tousoulis
D000818:Animals; D000975:Antioxidants / Q000008:administration & dosage* / Q000378:metabolism; D019587:Dietary Supplements; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D006333:Heart Failure / Q000178:diet therapy / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D018977:Micronutrients / Q000008:administration & dosage* / Q000378:metabolism; D014815:Vitamins / Q000008:administration & dosage* / Q000378:metabolism
D000975:Antioxidants; D018977:Micronutrients; D014815:Vitamins
Vitamin; cardiomyopathy; chronic heart failure; diet; anti-oxidants; metabolism; micronutrients