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Nutrition and Heart Failure: Impact of Drug Therapies and Management Strategies

From ¹ Department of Pharmacy Services, University of Kentucky, Lexington, Kentucky, ² University of Michigan College of Pharmacy, Ann Arbor, Michigan,³ University of Michigan Health-Systems and College of Pharmacy, Ann Arbor, Michigan, ⁴ University of Kentucky Department of Pharmacy Services and College of Pharmacy, Lexington, Kentucky,⁵ University of Utah College of Pharmacy, Salt Lake City, Utah, and ⁶ University of Wisconsin–Madison School of Pharmacy, Madison, Wisconsin.

Correspondence: Address correspondence to: Steven P. Dunn, Department of Pharmacy Services, University of Kentucky, 800 Rose Street, Rm H-112B, Lexington, KY 40536-0293; e-mail: sdunn3{at}email.uky.edu.

Nutrition impairment commonly occurs in patients with heart failure and affects disease progression. Vitamin and mineral deficiencies are associated with early mortality, particularly in patients classified as cachectic. Guideline-based therapies approved for heart failure, such as loop diuretics, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, aldosterone antagonists, and β-adrenergic blockers, can lead to electrolyte abnormalities and predispose to some vitamin and micronutrient deficits. Clinical trial evidence in support of supplementary vitamin and mineral therapies for heart failure patients is limited with the exception of documented calcium and possibly vitamin D, thiamine, and coenzyme Q₁₀ deficiencies. This area is gaining significant attention, and research is ongoing. The clinician can help minimize morbidity from nutrition impairment through appropriate monitoring and correction of baseline and medication-induced electrolyte imbalances, in addition to vitamin and mineral supplementation when appropriate.

Key Words: nutrition therapy • heart failure • vitamins • electrolytes • drug therapy

Nutrition in Clinical Practice, Vol. 24, No. 1, 60-75 (2009)
DOI: 10.1177/0884533608329299


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