Nutraceuticals in Patients With Heart Failure: A Systematic Review.

Dietary Supplements Fatty Acids, Omega-3 / administration & dosage Heart Failure / diagnosis Humans Randomized Controlled Trials as Topic / methods
Dietary supplements Omega-3 PUFAs antioxidant beetroot probiotics vitamin

Journal

Journal of cardiac failure
ISSN: 1532-8414
Titre abrégé: J Card Fail
Pays: United States
ID NLM: 9442138

Informations de publication

Date de publication:
Feb 2020
Historique:
received: 30 06 2019
revised: 07 10 2019
accepted: 29 10 2019
pubmed: 11 11 2019
medline: 12 6 2021
entrez: 10 11 2019
Statut: ppublish

Résumé

Nutraceuticals are pharmacologically active substances extracted from vegetable or animal food and administered to produce health benefits. We recently reviewed the current evidence for nutraceuticals in patients diagnosed with heart failure as part of the writing of the Australian Guidelines for the prevention, diagnosis, and management of heart failure. A systematic search for studies that compared nutraceuticals to standard care in adult patients with heart failure was performed. Studies were included if >50 patients were enrolled, with ≥6 months follow-up. If no studies met criteria then studies <50 patients and <6 months follow-up were included. The primary outcomes included mortality/survival, hospitalization, quality of life, and/or exercise tolerance. Iron was not included in this review as its role in heart failure is already well established. Forty studies met the inclusion criteria. The strongest evidence came from studies of polyunsaturated fatty acids, which modestly decreased mortality and cardiovascular hospitalizations in patients with mostly New York Heart Association class II and III heart failure across a range of left ventricular ejection fraction. Coenzyme Q10 may decrease mortality and hospitalization, but definite conclusions cannot be drawn. Studies that examined nitrate-rich beetroot juice, micronutrient supplementation, hawthorn extract, magnesium, thiamine, vitamin E, vitamin D, L-arginine, L-carnosine, and L-carnitine were too small or underpowered to properly appraise clinical outcomes. Only one nutraceutical, omega-3 polyunsaturated fatty acid, received a positive recommendation in the Australian heart failure guidelines. Although occasionally showing some promise, all other nutraceuticals are inadequately studied to allow any conclusion on efficacy. Clinicians should favor other treatments that have been clearly shown to decrease mortality.

Sections du résumé

BACKGROUND BACKGROUND
Nutraceuticals are pharmacologically active substances extracted from vegetable or animal food and administered to produce health benefits. We recently reviewed the current evidence for nutraceuticals in patients diagnosed with heart failure as part of the writing of the Australian Guidelines for the prevention, diagnosis, and management of heart failure.
METHODS METHODS
A systematic search for studies that compared nutraceuticals to standard care in adult patients with heart failure was performed. Studies were included if >50 patients were enrolled, with ≥6 months follow-up. If no studies met criteria then studies <50 patients and <6 months follow-up were included. The primary outcomes included mortality/survival, hospitalization, quality of life, and/or exercise tolerance. Iron was not included in this review as its role in heart failure is already well established.
RESULTS RESULTS
Forty studies met the inclusion criteria. The strongest evidence came from studies of polyunsaturated fatty acids, which modestly decreased mortality and cardiovascular hospitalizations in patients with mostly New York Heart Association class II and III heart failure across a range of left ventricular ejection fraction. Coenzyme Q10 may decrease mortality and hospitalization, but definite conclusions cannot be drawn. Studies that examined nitrate-rich beetroot juice, micronutrient supplementation, hawthorn extract, magnesium, thiamine, vitamin E, vitamin D, L-arginine, L-carnosine, and L-carnitine were too small or underpowered to properly appraise clinical outcomes.
CONCLUSION CONCLUSIONS
Only one nutraceutical, omega-3 polyunsaturated fatty acid, received a positive recommendation in the Australian heart failure guidelines. Although occasionally showing some promise, all other nutraceuticals are inadequately studied to allow any conclusion on efficacy. Clinicians should favor other treatments that have been clearly shown to decrease mortality.

Identifiants

DOI: 10.1016/j.cardfail.2019.10.014 PMID: 31704198
pubmed: 31704198
pii: S1071-9164(19)30715-8
doi: 10.1016/j.cardfail.2019.10.014
pii:
doi:

Substances chimiques

Fatty Acids, Omega-3 0

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

166-179

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Ingrid Hopper (I)

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Heart Centre, The Alfred Hospital, Melbourne, Australia. Electronic address: ingrid.hopper@monash.edu.

Cia Connell (C)

National Heart Foundation of Australia, Melbourne, Australia.

Tom Briffa (T)

Centre for Health Services Research and Cardiovascular Research Group, School of Population Health, University of Western Australia, Perth, Australia.

Carmine G De Pasquale (CG)

Department of Cardiovascular Medicine, Flinders Medical Centre & Flinders University, Adelaide, Australia.

Andrea Driscoll (A)

Department of Cardiology, Austin Health, Melbourne, Australia; School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia.

Peter M Kistler (PM)

Heart Centre, The Alfred Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.

Peter S Macdonald (PS)

St Vincent's Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia.

Andrew Sindone (A)

Heart Failure Unit and Department of Cardiac Rehabilitation, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.

Liza Thomas (L)

Department of Cardiology, Westmead Hospital, Department of Medicine, University of Sydney, Department of Medicine, University of New South Wales, Sydney, Australia.

John J Atherton (JJ)

Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia.

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Classifications MeSH

questionsmedicales.fr › Aliments et boissons › Aliments › Compléments alimentaires › Nutraceuticals in Patients With Heart Failure:...
questionsmedicales.fr › Lipides › Huiles › Huiles de poisson › Acides gras omega-3 › Nutraceuticals in Patients With Heart Failure:...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Nutraceuticals in Patients With Heart Failure:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Nutraceuticals in Patients With Heart Failure:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Nutraceuticals in Patients With Heart Failure:...