Thirty patients (mean age, 75.4 years) with heart failure (mean left ventricular ejection fraction [LVEF], 26.1%) were randomly assigned to receive, in double-blind fashion, a daily micronutrient supplement or placebo for 9 months. The supplement provided daily: calcium (250 mg), magnesium (150 mg), zinc (15 mg), copper (1.2 mg), selenium (50 mcg), vitamin A (800 mcg), thiamine (200 mg), riboflavin (2 mg), vitamin B6 (200 mg), folic acid (5 mg), vitamin B12 (200 mcg), vitamin C (500 mg), vitamin E (400 mg), vitamin D (400 IU), and coenzyme Q10 (CoQ10; 150 mg). All patients were on stable optimal medical therapy for at least three months before the start of the study. The mean left ventricular end-diastolic volume decreased by 13.1% in the active-treatment group and increased by 5.7% in the placebo group (p = 0.03 for the difference in the change between groups). The mean LVEF increased in the active-treatment group from 25.6% to 30.9%, and decreased in the placebo group from 26.6% to 26.2% (p = 0.03 for the difference in the change between groups). The mean quality-of-life score increased (improved) by 14.8% (p < 0.05 compared with baseline) in the active-treatment group, and decreased (worsened) by 1.6% in the placebo group (p = 0.02 for the difference in the change between groups).

Comment: The results of this study demonstrate that long-term micronutrient supplementation can improve left ventricular volume, left ventricular ejection fraction, and quality of life in elderly patients with heart failure. The beneficial effect was probably not due to any one nutrient, but rather to a combination of nutrients. CoQ10 has been reported in several uncontrolled trials to improve LVEF and cardiac function in patients with heart failure. Two double-blind studies, however, failed to find a beneficial effect of CoQ10. It is likely that some of the patients in these negative CoQ10 trials were deficient in other nutrients that play a role in myocardial function, such as thiamine, magnesium, and selenium. Had the patients in those studies been given a comprehensive nutritional-support program in addition to CoQ10 or placebo, the results may have been very different. Further research is needed to determine the optimal combination and doses of nutrients for the prevention and treatment of heart failure.

Witte KKA, et al. The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J 2005;26:2238-2244.