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European Heart Journal Advance Access originally published online on November 2, 2005
European Heart Journal 2006 27(1):117-118; doi:10.1093/eurheartj/ehi635
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Heart failure improvement from a supplement containing copper: reply

Klaus K. Witte

Division of Cardiology
University of Toronto
Mount Sinai Hospital
600 University Avenue
Toronto
Ontario M5G 1XA
Canada
Tel: +1 416 340 3141
Fax: +1 416 340 4862
E-mail address: klauswitte{at}hotmail.com

Andrew L. Clark

Department of Cardiology
University of Hull

Hull, HU16 5RX
UK

We are grateful for the comments by Prof. Klevay and we agree that copper supplementation in a population of elderly heart failure patients could have significant benefits. Our choice of agents and daily intakes in the study1 were generally made on the basis of previous animal and human work.2 However, although there are data on the prevalence and potential effects of copper deficiency,3 there are few about supplemental doses in humans at risk of deficiency.4 We were therefore cautious, choosing 1.2 mg per day based on recommended daily intakes.

The recent MAVIS study has demonstrated that multiple micronutrient supplementation is not of benefit in reducing morbidity from infections in otherwise well ambulatory elderly patients.5 However, patients with long-term multi-system illnesses, such as chronic heart failure (CHF), might be more likely to have important relative deficiencies in multiple micronutrients due to reduced intake, increased degradation because of metabolic stress, and increased excretion.6 In such patients, single agent supplementation might be ineffective or exacerbate deficiencies elsewhere with no overall change in status. Furthermore, the potential benefits of micronutrient supplementation in CHF given high re-admissions rates, poor overall quality of life, and persistent symptoms are significant.2

On the basis of our recent data, the prevalence of micronutrient deficiency including copper in patients with CHF and the effects of supplementation deserve further research.

References

  1. Witte KK, Nikitin NP, Parker AC, von Haehling S, Volk HD, Anker SD, Clark AL, Cleland JG. The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J. Published online ahead of print August 4, 2005.
  2. Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol 2001;37:1765–1774.[Abstract/Free Full Text]
  3. Allen KG, Klevay LM. Copper: an antioxidant nutrient for cardiovascular health. Curr Opin Lipidol 1994;5:22–28.[Medline]
  4. Klevay LM. Lack of a recommended dietary allowance for copper may be hazardous to your health. J Am Coll Nutr 1998;17:322–326.[Abstract/Free Full Text]
  5. Avenell A, Campbell MK, Cook JA, Hannaford PC, Kilonzo MM, McNeill G, Milne AC, Ramsay CR, Seymour DG, Stephen AI, Vale LD. Effect of multivitamin and multimineral supplements on morbidity from infections in older people (MAVIS trial): pragmatic, randomised, double blind, placebo controlled trial. BMJ 2005;331:324–329.[Abstract/Free Full Text]
  6. Witte KK, Clark AL. Nutritional abnormalities contributing to cachexia in chronic illness. Int J Cardiol 2002;85:23–31.[CrossRef][Web of Science][Medline]

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This Article
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27/1/117-a    most recent
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