Abstract
Heart failure (HF) is a complex clinical syndrome that represents a major cause of morbidity and mortality in Western countries. Several nutraceuticals have shown interesting clinical results in HF prevention as well as in the treatment of the early stages of the disease, alone or in combination with pharmacological therapy. The aim of the present expert opinion position paper is to summarise the available clinical evidence on the role of phytochemicals in HF prevention and/or treatment that might be considered in those patients not treated optimally as well as in those with low therapy adherence. The level of evidence and the strength of recommendation of particular HF treatment options were weighed up and graded according to predefined scales. A systematic search strategy was developed to identify trials in PubMed (January 1970 to June 2019). The terms 'nutraceuticals', 'dietary supplements', 'herbal drug' and 'heart failure' or 'left verntricular dysfunction' were used in the literature search. The experts discussed and agreed on the recommendation levels. Available clinical trials reported that the intake of some nutraceuticals (hawthorn, coenzyme Q10, l-carnitine, d-ribose, carnosine, vitamin D, probiotics, n-3 PUFA and beet nitrates) might be associated with improvements in self-perceived quality of life and/or functional parameters such as left ventricular ejection fraction, stroke volume and cardiac output in HF patients, with minimal or no side effects. Those benefits tended to be greater in earlier HF stages. Available clinical evidence supports the usefulness of supplementation with some nutraceuticals to improve HF management in addition to evidence-based pharmacological therapy.
Highlights
Heart failure (HF) prevalence in the USA is about 5 million individuals[1], while it affects more than 23 million individuals worldwide[2]
Based on the available data it was suggested that a low intake of some nutraceuticals, vitamins and minerals has been associated with an increased risk of developing HF, and supplementation with some nutraceuticals has been reported to improve different parameters related to HF, even on top of guidelinedriven conventional treatment
It has been supposed that the lack of amino acids (AA) intake or absorption could further impair myocardium metabolism in HF patients
Summary
Heart failure (HF) prevalence in the USA is about 5 million individuals[1], while it affects more than 23 million individuals worldwide[2]. Epidemiological studies and clinical trials have investigated the possibility that some dietary supplements and phytochemicals (overall referred to as natural products or nutraceuticals) can contribute to the improvement of HF-related symptoms (Fig. 1). The aim of this position paper is to provide, for the first time, physicians and nutrition experts with a practical tool presenting the scientific evidence on efficacy and safety of nutraceuticals, eventually supporting their use as further HF symptoms improvers, as an add-on to optimal pharmacological treatment
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