Why Japan Uses Taurine for Heart Failure
Taurine supplementation is used in Japan for heart failure based on historical practice and mechanistic rationale, but this approach is not supported by major international heart failure guidelines, which explicitly classify nutritional supplements including taurine as having unproven value and not recommended for routine treatment. 1
Guideline Position on Taurine
The ACC/AHA guidelines explicitly state that routine use of nutritional supplements including taurine for heart failure treatment is Class III (not recommended), with Level of Evidence C. 1
No major European or American heart failure guidelines from ESC (2001,2002,2005) or ACC/AHA (2001) include taurine in any treatment algorithm for heart failure management. 1
The only guideline mention of taurine relates to pediatric parenteral nutrition, where it should be included to prevent cholestasis and retinal dysfunction in infants, but this has no relevance to adult heart failure treatment. 1
Why Japan Adopted This Practice
The Japanese use of taurine appears to stem from:
Mechanistic research showing taurine antagonizes harmful effects of angiotensin II and catecholamines, which are key drivers of heart failure progression—the same targets that ACE inhibitors and beta-blockers address through proven mechanisms. 2, 3
Small studies demonstrating improvements in functional capacity, myocardial oxygen consumption, and electrical activity with 500mg three times daily for 2 weeks, though these were not adequately powered mortality trials. 4
Taurine's theoretical benefits include promoting natriuresis/diuresis, modest positive inotropic effects through calcium regulation, and attenuation of angiotensin II-induced cardiac remodeling. 2, 3
Critical Evidence Gap
A 2022 systematic review of taurine in human heart failure found only 11 studies meeting inclusion criteria, with only one deemed "high quality" by Newcastle-Ottawa Scale. 5
Meta-analysis showed no significant improvement in ejection fraction or stroke volume in all-cause heart failure patients (P<0.05). 5
No study was specific to dilated cardiomyopathy, and supplementation protocols varied wildly (500mg to 6g daily, 2 to 48 weeks duration). 5
The Correct Treatment Approach
Instead of taurine, guideline-directed medical therapy must be prioritized:
ACE inhibitors or ARBs as foundational therapy for systolic dysfunction (Class I, Level A evidence) 1, 6
Beta-blockers once clinically stable (Class I, Level A evidence) 1, 6
Diuretics for volume management and symptom relief (Class I, Level A evidence) 1, 6
Aldosterone antagonists (spironolactone) in NYHA Class III-IV to improve survival (Class I, Level B evidence) 1
Common Pitfall
The major pitfall is assuming that mechanistic plausibility (taurine's effects on calcium homeostasis and angiotensin II antagonism) translates to clinical benefit. While taurine appears safe with no significant adverse effects reported, 4, 5 safety alone does not justify use when proven life-saving therapies exist. 1
If a patient insists on taurine supplementation, it can be used cautiously (500mg three times daily) given low risk of harm, but counsel that it will not improve cardiac function or prognosis compared to guideline-directed medical therapy. 4, 5