European Heart Journal Advance Access originally published online on August 4, 2005
European Heart Journal 2005 26(21):2238-2244; doi:10.1093/eurheartj/ehi442
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The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure
1Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, UK
2Department of Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK
3Institute of Medical Immunology, Charité Medical School, Berlin, Germany
4Division of Applied Cachexia Research, Department of Cardiology, Charité, Berlin, Germany
Received 4 December 2004; revised 4 July 2005; accepted 13 July 2005; online publish-ahead-of-print 4 August 2005.
* Corresponding author. Tel: +44 1482 624073; fax: +44 1482 624071. E-mail address: klauswitte{at}hotmail.com
See page 2215 for the editorial comment on this article (doi:10.1093/eurheartj/ehi490)
Aims Chronic heart failure (CHF) is a common and leading cause of death in industrialized countries. The potential benefits of micronutrient supplementation in CHF are extensive. Therefore, we examined the influence of long-term multiple micronutrient supplementation on left ventricular (LV) function, levels of pro-inflammatory cytokines, and quality-of-life (QoL) in elderly patients with CHF.
Methods and results Thirty CHF patients [age 75.4 (0.7), mean (SEM), LV ejection fraction (LVEF) 
35%] were randomized to receive capsules containing a combination of high-dose micronutrients (calcium, magnesium, zinc, copper, selenium, vitamin A, thiamine, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, vitamin E, vitamin D, and Coenzyme Q10) or placebo for 9 months in a double-blind fashion. All subjects were on stable optimal medical therapy for at least 3 months before enrolment. At randomization and at study end, tumour necrosis factor-
and its soluble receptors TNFR-1 and TNFR-2 were measured and six-minute walk test and QoL were assessed. Cardiac magnetic resonance scanning was performed to evaluate cardiac dimensions and LVEF. Two patients died during follow-up. The remaining patients (14 randomized to placebo and 14 to micronutrients) were well matched for LV function, symptoms, and exercise capacity. At the end of the follow-up period, LV volumes were reduced in the intervention group with no change in the placebo group [–13.1 (17.1)% vs. +3.8 (10.0)%; P<0.05]. LVEF increased by 5.3±1.4% in the intervention group and was unchanged in the placebo group (P<0.05). Patients taking micronutrients also had a significant improvement in QoL score between enrolment and study end [+9.5 (1.6)%; P<0.05], whereas those taking placebo had a slight deterioration [–1.1 (0.8)%; P=0.12]. Six-minute walk test and inflammatory cytokine levels remained unchanged in both groups.
Conclusion Long-term multiple micronutrient supplementation can improve LV volumes and LVEF and QoL scores in elderly patients with heart failure due to LV systolic dysfunction.
Key Words: Chronic heart failure • Micronutrients • Quality-of-life • Cytokines
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