Abstract
There is evidence demonstrating that heart failure (HF) occurs in 1–2% of the global population and is often accompanied by comorbidities which contribute to increasing the prevalence of the disease, the rate of hospitalization and the mortality. Although recent advances in both pharmacological and non-pharmacological approaches have led to a significant improvement in clinical outcomes in patients affected by HF, residual unmet needs remain, mostly related to the occurrence of poorly defined strategies in the early stages of myocardial dysfunction. Nutritional support in patients developing HF and nutraceutical supplementation have recently been shown to possibly contribute to protection of the failing myocardium, although their place in the treatment of HF requires further assessment, in order to find better therapeutic solutions. In this context, the Optimal Nutraceutical Supplementation in Heart Failure (ONUS-HF) working group aimed to assess the optimal nutraceutical approach to HF in the early phases of the disease, in order to counteract selected pathways that are imbalanced in the failing myocardium. In particular, we reviewed several of the most relevant pathophysiological and molecular changes occurring during the early stages of myocardial dysfunction. These include mitochondrial and sarcoplasmic reticulum stress, insufficient nitric oxide (NO) release, impaired cardiac stem cell mobilization and an imbalanced regulation of metalloproteinases. Moreover, we reviewed the potential of the nutraceutical supplementation of several natural products, such as coenzyme Q10 (CoQ10), a grape seed extract, Olea Europea L.-related antioxidants, a sodium–glucose cotransporter (SGLT2) inhibitor-rich apple extract and a bergamot polyphenolic fraction, in addition to their support in cardiomyocyte protection, in HF. Such an approach should contribute to optimising the use of nutraceuticals in HF, and the effect needs to be confirmed by means of more targeted clinical trials exploring the efficacy and safety of these compounds.
Highlights
Heart failure (HF) represents a multifactorial disease state with a global prevalence of1–2% in the population [1]
Recent studies exploring pathophysiological mechanisms characterizing the early stages of heart failure (HF), mostly in the course of cardiometabolic disorders underlying impaired myocardial dysfunction, have allowed the possible identification of a condition of “cardiomyocyte frailty” in which oxidative stress and mitochondrial dysfunction seem to play a crucial role
Protective mechanisms which include autophagic responses and endogenous anti-oxidant enzyme overexpression are activated to antagonise the apoptotic cell death of myocardial cells
Summary
Heart failure (HF) represents a multifactorial disease state with a global prevalence of. Comorbidities frequently associated with HF are hypertension, diabetes, and obesity or hyperlipidaemia These comorbidities thereby increase the prevalence of the disease, the rate of hospitalisation, and mortality [2,3]. Growing evidence has suggested that greater control of the nutritional balance in patients experiencing HF (with special regards to the micronutrient and nutraceutical supply) leads to a significant improvement in the symptoms and consequences of the disease [5,6,7]. There is evidence that the majority of HF patients exhibit an insufficient support of micronutrients and that such a condition leads to an increased prevalence of the disease [13,14,15,16].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
