Supplements for Heart Failure Patients?

Last month we discussed the soaring costs from multiple trips to the hospital in patients with heart failure (HF) and the how more limiting salt intake more ag- gressively in stable ambulatory HF patients reduced those hospital admissions. This month we will look at other nutritional strategies that may also reduce morbidity and mortality in ambulatory HF patients.Can Increased Omega-3 Intake Reduce HF?In 2009 Harvard University, along with researchers in Sweden, published a study that followed about 40,000 men aged 45-79 without established heart disease or diabetes for six years. The men were divided into 5 groups based on their intake of seafood containing long chain omega-3 fatty acids. The lowest omega-3 group, which consumed no seafood, were about 33% more likely to be diagnosed with HF than those who were consuming about one serving of seafood a week.1A Japanese study also showed those who consumed more omega-3s from fish were significantly less likely to develop HF.2 An American study failed to find an association between fish intake and HF but in the USA a large propor- tion of fish is fried, which is low in omega-3s and may be rich in trans fat and/or other harmful substances which may explain the apparent lack of benefit.A recent study by Dr. Gheorghiade and others at Northwestern University randomly assigned a group of 133 subjects with stable HF to receive either a placebo or 2g of long-chain omega-3 fatty acids. After two years, the patients receiving the omega-3 supplement showed a 10.4% increase in heart function while the average heart function of those on the placebo declined another 5%. They also observed a 6.2% increase in blood oxygen levels in the omega-3 group and an average decrease of 4.5% in the placebo group. Aerobic exercise capacity increased 7.5% in the omega-3 group and fell 4.8% in the placebo group. And hospitalization over 2 years was 30% for those on the placebo but only 6% for those on the omega-3 supplement. The results were published in the Journal of Ameri- can Cardiology online Jan. 5, 2011.In about half of HF patients there is a large build-up of fibrotic (scar-like) tissue in the heart that so stiffens the heart its pumping efficiency is severely compromised. This leads leads to what is called diastolic HF. A recent study using an animal model of HF found that omega-3 fatty acids helped prevent the buildup of this fibrotic tissue in the heart by blocking TGF-beta1 activation of a metabolic pathway leading to the production of more collagen by heart cells.3Bottom Line: Omega-3-rich seafood should be part of a heart healthy diet and those who consume little or no fish may well benefit from a daily 0.5 to 2g Omega-3 supplement.Can CoQ10 Supplements Improve Exercise Tolerance in HF Patients? Italian researchers looked at the impact of a supplement of 100mg of CoQ10 in a group of 23 patients with HF. Compared to those receiving the placebo those taking the CoQ10 showed a 9% increase in their heart’s functional capacity as measured by peak oxygen consumption during exercise. This study also showed a 38% improvement in blood flow as measured by dilation of the brachial artery.4 Other studies show increased mortality in patients with HF and low levels of CoQ10 in their blood. Most HF patients will be on statin drugs, which are known to reduce the body’s production of CoQ10.Bottom Line: Given the low risk of harm coupled with growing evidence of potential benefit for some HF patients it seems reasonable to suggest HF patients take a supplement with about 75 to 150mg, particularly if they are taking statin drugs.By James J. Kenney, PhD, RD, FACN.References: 1. Levitan EB, et al. Eur HeartJ 2009;30:1495-1500 2. Yamagishi K, et al. Am CollCardiol 2008;52:988-96 3. Chen J, et al. Circulation2011;123:584-934. doi:10.1093/eurheartj/ ehl158