CHF leads to breathlessness, fatigue, and accumulation of fluid in the lungs or the veins (primarily in the legs) or both.
Healthy Lifestyle Tips
Even with severe disease, appropriate exercise can benefit those with CHF.1, 2 In a controlled trial, long-term (one year) exercise training led to improvements in quality of life and functional capacity in people with CHF.3 Nonetheless, too much exercise can be life-threatening for those with CHF. How much is “too much” varies from person to person; therefore, any exercise program undertaken by someone with CHF requires professional supervision.
Non-steroidal anti-inflammatory drugs (NSAIDs) appear to significantly increase the risk of CHF. The use of NSAIDs in one preliminary study was found to double the likelihood of hospital admission with CHF the following week. This likelihood increased by more than 10 times for patients with a history of heart disease.4 This study did not include people taking low-dose aspirin.
Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
850 to 882 mg per day
In a double-blind study of people with chronic heart failure, a combination of EPA and DHA for four years resulted in a small but statistically significant protection against death or hospitalization for cardiovascular reasons.
In a double-blind study of patients with chronic heart failure, supplementation with the fatty acids present in fish oil for an average of four years resulted in a small but statistically significant decrease in the number of patients who died or were hospitalized for cardiovascular reasons. The treatment consisted of 850 to 882 mg per day of a mixture of eicosapentaenoic acid and docosahexaenoic acid (as their ethyl esters).5 In another double-blind trial, supplementation with eicosapentaenoic acid and docosahexaenoic acid improved heart function and decreased the number of hospitalizations in patients with heart failure due to dilated cardiomyopathy.6
80 to 300 mg of standardized herbal extract two to three times per day with a doctor's supervision
Antioxidant hawthorn appears to reduce symptoms and improve exercise capacity by increasing blood flow to the heart and the strength of heart contractions, and reducing resistance to blood flow in the extremities.
Clinical trials have shown that standardized extracts made from the leaves and flowers of hawthorn are effective in helping people with early-stage CHF.7, 8, 9 Hawthorn extracts appear to increase blood flow to the heart, increase the strength of heart contractions, reduce resistance to blood flow in the extremities, and act as an antioxidant.10, 11, 12 In a large preliminary trial, people with mild to moderate CHF were given 300 mg of hawthorn flower and leaf extract (standardized to contain 2.2% flavonoids) three times a day for two months.13 Symptoms of CHF—including heart palpitations, chest pressure, and swelling in the extremities—decreased throughout the trial during the use of hawthorn. The efficacy of hawthorn for the treatment of CHF has been confirmed in a double-blind trial.14
Hawthorn extracts are available in capsules or tablets standardized to either total flavonoid content (usually 2.2%) or oligomeric procyanidins (usually 18.75%). Doctors who work with herbal medicine often suggest 80–300 mg two to three times per day. Hawthorn berry products that are not standardized may be weaker, and the recommended amount is typically 4 to 6 grams per day for the whole herb, or 4–5 ml of the tincture three times per day.
500 mg two to three times per day with a doctor's supervision
Supplementing with L-carnitine can improve heart function and exercise capacity and reduce heart muscle damage due to insufficient oxygen.
People with CHF have insufficient oxygenation of the heart, which can damage the heart muscle. Such damage may be reduced by taking L-carnitine supplements.15 L-carnitine is a natural substance made from the amino acidslysine and methionine. Levels of L-carnitine are low in people with CHF;16 therefore, many doctors recommend that those with CHF take 500 mg of L-carnitine two to three times per day.
Most L-carnitine/CHF research has used a modified form of the supplement called propionyl-L-carnitine (PC). In one double-blind trial, people using 500 mg of PC per day had a 26% increase in exercise capacity after six months.17 In double-blind research, other indices of heart function have also improved after taking 1 gram of PC twice per day.18 It remains unclear whether propionyl-L-carnitine has unique advantages over L-carnitine, as limited research in animals and humans has also shown very promising effects of the more common L-carnitine.19
300 mg daily with a doctor's supervision
Supplementing with this essential mineral can prevent a deficiency that can lead to heart arrhythmias.
Magnesium deficiency frequently occurs in people with CHF, and such a deficiency may lead to heart arrhythmias. Magnesium supplements have reduced the risk of these arrhythmias.20 People with CHF are often given drugs that deplete both magnesium and potassium; a deficiency of either of these minerals may lead to an arrhythmia.21 Many doctors suggest magnesium supplements of 300 mg per day.
2 grams three times per day with a doctor's supervision
Taurine, an amino acid, helps increase the force and effectiveness of heart muscle contractions.
Taurine, an amino acid, helps increase the force and effectiveness of heart-muscle contractions. Research (some double-blind) has shown that taurine helps people with CHF.22, 23, 24, 25 Most doctors suggest taking 2 grams three times per day.
5.6 to 15 grams per day with a doctor's supervision
The body needs arginine to make nitric oxide, which increases blood flow. This process is impaired in people with CHF. It also has been shown to improve kidney function in people with CHF.
The body needs arginine, another amino acid, to make nitric oxide, which increases blood flow. This process is impaired in people with CHF. Arginine supplementation (5.6–12.6 grams per day) has been used successfully in double-blind trials to treat CHF.26A double-blind trial has also found that arginine supplementation (5 grams three times daily) improves kidney function in people with CHF.27
Arjun Bark Extract
500 mg of bark extract three times per day with a doctor's supervision
A small trial found that supplementing with a bark extract of arjun improved heart function and lung congestion in patients with severe CHF.
A small clinical trial found that supplementation with a bark extract of arjun (Terminalia arjuna) improved heart function as well as lung congestion in patients with severe CHF.28 Patients in the study took 500 mg of arjun extract three times per day and began to exhibit significant improvement in heart function within two weeks; improvement continued over the course of approximately two years. The herb extract used in this study was concentrated but not standardized for any particular constituent. Commercial preparations are sometimes standardized to contain 1% arjunolic acid. Larger clinical trials are needed to confirm the results of this small study.
300 to 500 mg four times per day with a doctor's supervision
Berberine has been shown to significantly improve heart function and exercise capacity and reduce the frequency of arrhythmias in people with congestive heart failure.
Berberine is used in Asia to treat congestive heart failure. In a double-blind trial, supplementation with berberine (300 to 500 mg, four times per day) for eight weeks significantly improved heart function and exercise capacity and reduced the frequency of arrhythmias in people with congestive heart failure.29
0.9 mg daily per pound of body weight with a doctor's supervision
CoQ10 enhances the production of energy in the heart muscle and has been reported to help people with CHF, sometimes dramatically.
As is true for several other heart conditions, coenzyme Q10 (CoQ10) has been reported to help people with congestive heart failure,30, 31 sometimes dramatically.32 Positive effects have been confirmed in double-blind research33 and in an overall analysis of eight controlled trials.34 However, some double-blind trials have reported modest35 or no improvement36, 37, 38 in exercise capacity or overall quality of life. Most CoQ10 research used 90–200 mg per day. The beneficial effects of CoQ10 may not be seen until after several months of treatment. In one preliminary trial, treatment with ubiquinol (the chemically reduced form of CoQ10) was beneficial for people with severe heart failure, after the standard form of CoQ10 had been ineffective.39 Discontinuation of CoQ10 supplementation in people with congestive heart failure has resulted in severe relapses and should only be attempted under the supervision of a doctor.40
160 to 900 mg daily of a standardized herbal extract with a doctor's supervision
Studies have found hawthorn to be effective for the signs and symptoms of early-stage congestive heart failure, the main complication of cardiomyopathy.
Many doctors expert in herbal medicine consider hawthorn to be an effective and low-risk therapy for congestive heart failure, the main complication of cardiomyopathy. Rigorous clinical trials have now confirmed the effectiveness of hawthorn for the signs and symptoms of early-stage congestive heart failure,41, 42, 43, 44, 45 though hawthorn studies with cardiomyopathy patients have yet to be conducted. The clinical trials with heart-failure patients have demonstrated efficacy using 80 to 300 mg of standardized extract of hawthorn leaves and flowers two to three times per day.
Consult a qualified healthcare practitioner
Potassium can be beneficial for heart patients, but talk to your doctor first. Several drugs for CHF may cause potassium retention, making extra potassium dangerous.
Magnesium deficiency frequently occurs in people with CHF, and such a deficiency may lead to heart arrhythmias. Magnesium supplements have reduced the risk of these arrhythmias.46 People with CHF are often given drugs that deplete both magnesium and potassium; a deficiency of either of these minerals may lead to an arrhythmia.47 Many doctors suggest magnesium supplements of 300 mg per day.
Whole fruit and fruit and vegetable juice, which are high in potassium, are also recommended by some doctors. One study showed that elderly men who consumed food prepared with potassium-enriched salt (containing about half potassium chloride and half sodium chloride) had a 70% reduction in deaths due to heart failure and a significant reduction in medical costs for cardiovascular disease, when compared with men who continued to use regular salt.48 While increasing potassium intake can be beneficial for heart patients, this dietary change should be discussed with a healthcare provider, because several drugs given to people with CHF may actually cause retention of potassium, making dietary potassium, even from fruit, dangerous.
Refer to label instructions
Coleus contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.
Coleus contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.49 Recent clinical trials indicate that forskolin improves heart function in people with congestive heart failure and cardiomyopathy.50, 51 A preliminary trial found that forskolin reduced blood pressure and improved heart function in people with cardiomyopathy. These trials have used intravenous infusions of isolated forskolin. It is unknown whether oral coleus extracts would have the same effect. While many doctors expert in herbal medicine would recommend 200–600 mg per day of a coleus extract containing 10% forskolin, these amounts are extrapolations and have yet to be confirmed by direct clinical research.
Refer to label instructions
In preliminary research, the prevalence of vitamin D deficiency was significantly higher in patients with congestive heart failure than in patients without it.
In one study, the prevalence of vitamin D deficiency was significantly higher in patients with CHF than in patients without CHF (28% vs. 22%). In that study, heart failure patients who received vitamin D supplementation (usually 800 to 1,000 IU per day) had a 32% lower death rate, compared with heart failure patients who did not receive vitamin D supplementation.52 Placebo-controlled trials are needed to confirm these preliminary observations.
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8. Schmidt U, Kuhn U, Ploch M, Hübner W-D. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1(1):17-24.
9. Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005312.
10. Maevers VW, Hensel H. Changes in local myocardial blood flow following oral administration of a Crataegus extract to non-anesthetized dogs. Arzneimittelforschung 1974;24:783-5.
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12. Bahorun T, Trotin F, Pommery J, et al. Antioxidant activities of Crataegus monogyna extracts. Planta Med 1994; 60:323-8.
13. Schmidt U, Albrecht H, Podzuweit M, et al. High-dose crataegus therapy in patients suffering from congestive heart failure NYHA class I and II. Z Phytotherapie 1998;19:22-30.
14. Rietbrock N, Hamel M, Hempel B, et al. Actions of standardized extract of Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure [in German]. Arzneimittelforschung 2001;51:793-8.
15. Bartels GL, Remme WJ, Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol 1994;74:125-30.
16. Suzuki Y, Masumura Y, Kobayashi A, et al. Myocardial carnitine deficiency in chronic heart failure. Lancet 1982;i:116 (letter).
17. Mancini M, Rengo F, Lingetti M, et al. Controlled study on the therapeutic efficacy of propionyl-L-carnitine in patients with congestive heart failure. Arzneimittelforschung 1992;42:1101-4.
18. Pucciarelli G, Mastursi M, Latte S, et al. The clinical and hemodynamic effects of propionyl-L-carnitine in the treatment of congestive heart failure. Clin Ther 1992;141:379-84.
19. Kobayashi A, Masumura Y, Yamazaki N. L-carnitine treatment for congestive heart failure—experimental and clinical study. Jpn Circ J 1992;56:86-94.
20. Bashir Y, Sneddon JF, Staunton A, et al. Effects of long-term oral magnesium chloride replacement in congestive heart failure secondary to coronary artery disease. Am J Cardiol 1993;72:1156-62.
21. Packer M, Gottlieb SS, Kessler PD. Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Am J Med 1986;80 (Suppl 4A):23-9.
22. Azuma J, Sawamura A, Awata N, et al. Double-blind randomized crossover trial of taurine in congestive heart failure. Curr Ther Res 1983;34(4):543-57.
23. Azuma J, Hasegawa H, Sawamura N, et al. Taurine for treatment of congestive heart failure. Int J Cardiol 1982;2:303-4.
24. Azuma J, Hasegawa H, Sawamura A, et al. Therapy of congestive heart failure with orally administered taurine. Clin Ther 1983;5(4):398-408.
25. Azuma J, Takihara K, Awata N, et al. Taurine and failing heart: experimental and clinical aspects. Prog Clin Biol Res 1985;179:195-213.
26. Rector TS, Bank A, Mullen KA, et al. Randomized, double-blind, placebo controlled study of supplemental oral L-arginine in patients with heart failure. Circulation 1996;93:2135-41.
27. Watanabe G, Tomiyama H, Doba N. Effects of oral administration of L-arginine on renal function in patients with heart failure. J Hypertens 2000;18:229-34.
28. Bharani A, Ganguly A, Bhargava KD. Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure. Int J Cardiol 1995;49:191-9.
29. Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol2003;92:173-6.
30. Mortensen SA, Vadhanavikit S, Baandrup U, Folkers K. Long-term coenzyme Q10 therapy: a major advance in the management of resistant myocardial failure. Drugs Exp Clin Res 1985;11:581-93.
31. Soongswang J, Sangtawesin C, Durongpisitkul K, et al. The effect of coenzyme Q10 on idiopathic chronic dilated cardiomyopathy in children. Pediatr Cardiol 2005;26:361-6.
32. Folkers K, Langsjoen P, Langsjoen PH. Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant. Biochem Biophys Res Commun 1992;15:247-53.
33. Morisco C, Trimarco B, Condorelli M. Effect of coenzyme Q10 in patients with congestive heart failure: a long-term multicenter randomized study. Clin Invest 1993;71:S134-6.
34. Soja AM, Mortensen SA. Treatment of chronic cardiac insufficiency with coenzyme Q10, results of meta-analysis in controlled clinical trials. Ugeskr Laeger 1997;159:7302-8.
35. Hofman-Bang C, Rehnqvist N, Swedberg K, et al. Coenzyme Q10 as an adjunctive in the treatment of chronic congestive heart failure. The Q10 Study Group. J Card Fail 1995;1:101-7.
36. Permanetter B, Rossy W, Klein G, et al. Ubiquinone (coenzyme Q10) in the long-term treatment of idiopathic dilated cardiomyopathy. Eur Heart J 1992;13:1528-33.
37. Watson PS, Scalia GM, Galbraith A, et al. Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure. J Am Coll Cardiol 1999;33:1549-52.
38. Khatta M, Alexander BS, Krichten CM, et al. The effect of coenzyme Q10 in patients with congestive heart failure. Ann Intern Med 2000;132:636-40.
39. Langsjoen PH, Langsjoen AM. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors 2008;32:119-28.
40. Mortensen SA, Vadhanavikit S, Baandrup U, Folkers K. Long-term coenzyme Q10 therapy: a major advance in the management of resistant myocardial failure. Drugs Exp Clin Res 1985;11:581-93.
41. Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure. Fortschr Med 1996;114:291-6 [in German].
42. Weihmayr T, Ernst E. Therapeutic effectiveness of Crataegus. Fortschr Med 1996;114:27-9 [in German].
43. Leuchtgens H. Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study. Fortschr Med 1993;111:352-4 [in German].
44. Schmidt U, Kuhn U, Ploch M, Hübner W-D. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1(1):17-24.
45. Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005312.
46. Bashir Y, Sneddon JF, Staunton A, et al. Effects of long-term oral magnesium chloride replacement in congestive heart failure secondary to coronary artery disease. Am J Cardiol 1993;72:1156-62.
47. Packer M, Gottlieb SS, Kessler PD. Hormone-electrolyte interactions in the pathogenesis of lethal cardiac arrhythmias in patients with congestive heart failure. Am J Med 1986;80 (Suppl 4A):23-9.
48. Chang HY, Hu YW, Yue CSJ, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 2006;83:1289-96.
49. Lindner E, Dohadwalla AN, Bhattacharya BK. Positive inotropic and blood pressure lowering activity of a diterpene derivative isolated from Coleus forskohli: Forskolin. Arzneimittelforschung. 1978;28:284-9.
50. Baumann G, Felix S, Sattelberger U, Klein G. Cardiovascular effects of forskolin (HL 362) in patients with idiopathic congestive cardiomyopathy—a comparative study with dobutamine and sodium nitroprusside. J Cardiovasc Pharmacol 1990;16:93-100.
51. Kramer W, Thormann J, Kindler M, Schlepper M. Effects of forskolin on left ventricular function in dilated cardiomyopathy. Arzneimittelforschung 1987;37:364-7.
52. Gotsman I, Shauer A, Zwas DR, et al. Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome. Eur J Heart Fail 2012;14:357-66.
The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.
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