Congestive heart failure is a systemic illness

A role for minerals and micronutrients

Shadwan Alsafwah, Stephen P. LaGuardia, Maximiliano Arroyo, Brian K. Dockery, Syamal Bhattacharya, Robert A. Ahokas, Kevin P. Newman

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

Congestive heart failure (CHF) is a clinical syndrome that features a failing heart together with signs and symptoms arising from renal retention of salt and water, mediated by attendant neurohormonal activation, and which prominently includes the renin-angiotensin-aldosterone system. More than this cardiorenal perspective, CHF is accompanied by a systemic illness whose features include an altered redox state in diverse tissues and blood, an immunostimulatory state with proinflammatory cytokines and activated lymphocytes and monocytes, and a wasting of tissues that includes muscle and bone. Based on experimental studies of aldosteronism and clinical findings in patients with CHF, there is an emerging body of evidence that secondary hyperparathyroidism is a covariant of CHF. The aldosteronism of CHF predisposes patients to secondary hyperparathyroidism because of a chronic increase in Ca 2+ and Mg 2+ losses in urine and feces, with a fall in their serum ionized levels and consequent secretion of parathyroid hormone. Secondary hyperparathyroidism accounts for bone resorption and contributes to a fall in bone strength that can lead to nontraumatic fractures. The long-term use of a loop diuretic with its attendant urinary wasting of Ca 2+ and Mg 2+ further predisposes patients to secondary hyperparathyroidism and attendant bone loss. Aberrations in minerals and micronutrient homeostasis that includes Ca 2+, Mg 2+, vitamin D, zinc and selenium appear to be an integral component of pathophysiologic expressions of CHF that contributes to its systemic and progressive nature. This broader perspective of CHF, which focuses on the importance of secondary hyperparathyroidism and minerals and micronutrients, raises the prospect that dietary supplements could prove remedial in combination with the current standard of care.

Original languageEnglish (US)
Pages (from-to)238-243
Number of pages6
JournalClinical Medicine and Research
Volume5
Issue number4
DOIs
StatePublished - Dec 1 2007

Fingerprint

Micronutrients
Minerals
Secondary Hyperparathyroidism
Heart Failure
Hyperaldosteronism
Bone and Bones
Sodium Potassium Chloride Symporter Inhibitors
Ergocalciferols
Standard of Care
Renin-Angiotensin System
Bone Resorption
Selenium
Dietary Supplements
Parathyroid Hormone
Feces
Signs and Symptoms
Oxidation-Reduction
Zinc
Monocytes
Homeostasis

All Science Journal Classification (ASJC) codes

  • Medicine(all)
  • Community and Home Care

Cite this

Congestive heart failure is a systemic illness : A role for minerals and micronutrients. / Alsafwah, Shadwan; LaGuardia, Stephen P.; Arroyo, Maximiliano; Dockery, Brian K.; Bhattacharya, Syamal; Ahokas, Robert A.; Newman, Kevin P.

In: Clinical Medicine and Research, Vol. 5, No. 4, 01.12.2007, p. 238-243.

Research output: Contribution to journalReview article

Alsafwah, Shadwan ; LaGuardia, Stephen P. ; Arroyo, Maximiliano ; Dockery, Brian K. ; Bhattacharya, Syamal ; Ahokas, Robert A. ; Newman, Kevin P. / Congestive heart failure is a systemic illness : A role for minerals and micronutrients. In: Clinical Medicine and Research. 2007 ; Vol. 5, No. 4. pp. 238-243.
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