Heart failure (HF) is a syndrome of cardiac dysfunction in which the heart can no longer pump enough blood around the body to support its organs and systems. HF afflicts over 5 million persons in the United States, at a cost of over $30 billion yearly. HF accounts for over 1 million hospital admissions yearly and is the cause of 1 out of every 9 deaths. With over 800,000 hospital admissions for HF occurring each year, despite only a minority ending up truly requiring acute care, hospital initiatives have been launched to decrease readmissions for HF within the first 30 days of discharge.
The traditional treatment of heart failure includes pharmacological agents like beta-blockers, ACE inhibitors and diuretics. In some cases, devices that synchronize the heart known as bi-ventricular pacing combined with defibrillators may help. Heart support devices and cardiac transplant are the most dramatic responses to the damaged heart with HF. Recently, at least two nutraceutical based therapies of HF have been tested and have shown promise to strengthen the heart in HF patients.
An antioxidant and critical component of cardiac energy production, CoQ10 is concentrated in healthy heart muscle and can become deficient in the muscle cells of patients suffering from HF. A meta-analysis of 11 studies, assessing CoQ10 supplementation (60-200 mg/day) over 1-6 months, found there was a 3.7 percent increase in ejection fraction (EF which is a measure of heart function) using CoQ10 supplementation. The most definitive evidence, the Q-SYMBIO study, was a placebo-controlled, double-blind, randomized trial of patients with chronic HF. In this study, 420 HF patients were randomized to CoQ10 (100 mg TID) or placebo and followed for 2 years. The long-term, primary endpoint of a composite of major adverse cardiovascular events was reached by 26 percent of the placebo, vs. only 15 percent of the CoQ10 group. In addition, cardiovascular mortality, all-cause mortality, and incidence of hospital stays for chronic HF were significantly lower in the CoQ10 treatment arm.
Recently, the role of vitamin D therapy in patients with HF and low levels of this vitamin/prohormone was studied (J Am Coll Cardiol. 2016;():. doi:10.1016/j.jacc.2016.03.508). Researchers enrolled 229 patients (179 men) with HF and vitamin D deficiency. Participants were either allocated to one year of vitamin D3 supplementation (4000IU D3 daily) or matching placebo. After one year of high-dose vitamin D supplementation, a significant improvement in cardiac function on echocardiography (left ventricular EF +6.07 percent (95 percent CI 3.20, 8.95; p<0.0001) was measured. There were no clinically significant effects on calcium levels or renal function.
Advances in the therapy of HF in the past decades are notable but the syndrome still poses a major challenge to clinicians and patients. Supplemental nutraceutical therapies are rarely considered in either the hospital or outpatient setting. I have seen tremendous benefit in my practice using supplements to augment standard HF therapy. The safety and low cost of both vitamin D and coQ10 are well established and the benefits are worthy of routine application in HF.