Is Micronutrient Supplementation Next Step For Managing Hear
Nutrition is one of the cornerstones of preventive cardiovascular medicine. However, aside from low cholesterol and low-salt regimens, physicians usually do not encourage specific diets in patients with cardiovascular disease. Nutrition supplementation is also very rarely prescribed, with the exception of omega-3 supplements, which have failed to obtain high-grade recommendation in the absence of strong evidence of their benefit.

The authors show convincing evidence building the case for micronutrients being an important component in HF. A detailed evaluation of current evidence regarding coenzyme Q10, zinc, copper, selenium, and iron is provided. B Micronutrients are key to the efficient use of macronutrients to produce ATP. These micronutrient deficits, present in up to 50% of patients, might actually promote the concept of “an engine out of fuel” in HF because of such deficits.

Among these five micronutrients (coenzyme Q10, zinc, copper, selenium, and iron), only iron is part of the routine daily practice of an HF physician. Indeed, in the 2021 ESC guidelines on HF, it is recommended that all patients with HF be periodically screened for iron deficiency (class I) and that intravenous (IV) iron supplementation should be considered in symptomatic HF patients recently hospitalized for HF with left ventricular ejection fraction (LVEF) <50% and iron deficiency (ferritin <100 ng/ml or serum ferritin 100–299 ng/ml with transferin saturation [TSAT] <20%) to reduce the risk of HF hospitalization (class IIa).