From the Guidelines
Thiamine, vitamin B6, and folate supplementation is not recommended for heart failure management based on current evidence, as it has not been shown to improve outcomes in patients with heart failure 1. However, thiamine deficiency can worsen heart failure by impairing energy metabolism in cardiac cells, and patients with heart failure, especially those taking loop diuretics, are at higher risk for thiamine deficiency. Vitamin B6 helps regulate homocysteine levels, with elevated homocysteine being a risk factor for cardiovascular disease, and folate works with vitamin B12 to reduce homocysteine levels, potentially decreasing inflammation and oxidative stress that can worsen heart failure. Some studies have suggested that folate fortification may contribute to the reduction of stroke mortality, at least at the level of primary prevention 1. However, large randomized studies like the VISP, NORVIT, and HOPE-2 trials have provided disappointing results, showing no significant effect of homocysteine-lowering treatment on cardiovascular risk 1. Key points to consider include:
- Thiamine deficiency can worsen heart failure
- Vitamin B6 and folate may help regulate homocysteine levels
- Current evidence does not support supplementation for heart failure management
- Folate fortification may have benefits in primary prevention of stroke mortality
- Large randomized studies have shown no significant effect of homocysteine-lowering treatment on cardiovascular risk.
From the Research
Thiamine and Heart Failure
- Thiamine deficiency is prevalent in patients with congestive heart failure, and supplementation may help improve left ventricular ejection fraction (LVEF) 2, 3.
- Thiamine deficiency can impair cardiac performance and exacerbate heart failure symptoms, making it a potential target for management 4.
- However, a systematic review and meta-analysis found no significant benefit of thiamine supplementation on clinical outcomes in patients with heart failure, including LVEF and symptom changes 5.
Vitamin B6 and Heart Failure
- There is limited evidence directly linking vitamin B6 to heart failure management.
- However, vitamin B6 is involved in various physiological processes, including energy metabolism and homocysteine regulation, which may be relevant to heart health.
Folate and Heart Failure
- Like vitamin B6, there is limited direct evidence linking folate to heart failure management.
- Folate is involved in homocysteine regulation and may have indirect effects on cardiovascular health, but its specific role in heart failure is not well established.
Overall Relationship
- Thiamine, vitamin B6, and folate are all B vitamins that play important roles in energy metabolism and other physiological processes.
- While thiamine deficiency has been linked to heart failure and supplementation may have potential benefits, the evidence for vitamin B6 and folate is less clear 6.