Characteristics of Thiamin and Its Relevance to the Management of Heart Failure

Abstract

Heart failure (HF) is a major public health problem in the United States that puts a significant burden on both patients and the healthcare system. The prevalence of malnutrition in HF patients is well-known and correlates with a dramatic decline in quality of life and disease progression, and is associated with high morbidity and mortality rates. The implication of HF on micronutrient status is underrecognized in the quest to offer "best practice" medical, device, and surgical interventions to this population. The micronutrient thiamin is of particular interest in the management of HF for several reasons: (a) HF is a disease of the elderly whose micronutrient status is in need of attention; (b) HF patients tend to have inadequate nutrient intake, which has been associated with thiamin deficiency; (c) thiamin deficiency (wet beriberi) impairs cardiac performance and can mimic the signs and symptoms of HF thereby potentially exacerbating the underlying disease; (d) use of loop diuretics to manage fluid and sodium imbalances associated with HF may cause the hyperexcretion of thiamin, thereby increasing the risk of deficiency; and (e) the prevention of thiamin deficiency should be a routine component in the overall management of this disease.

Thiamine Supplementation in Patients with Chronic Heart Failure Receiving Optimum Medical Treatment

“…Thiamine deficiency further impairs cardiac performance in heart failure [13], and can mimic its signs and symptoms [5]. It is possible that thiamine supplementation has some useful effects in the patients with heart failure [2,3,17] by prevention or correction of thiamine deficiency in heart failure [4,13,14], but this is controversial [2,4,7,17,21].…”

“…There are some evidences that heart failure patients might be thiamine deficient in comparison to healthy controls [4][5][6][7][8][9][10]; Heart failure patients tend to have inadequate nutrient intake [3][4][5], on the other hand, loop [4,5,[11][12][13][14][15][16] and all other diuretics [11,15] that may be used in heart failure may cause the hyperexcretion of thiamine [2,4,5,[13][14][15]17], hence chronic diuretic treatment has been related to thiamine deficiency in a high risk patient (such as an elderly) in some [2,6,11,13,17,18] but not all of the studies [7,19,20]. Thiamine deficiency further impairs cardiac performance in heart failure [13], and can mimic its signs and symptoms [5].…”

Evidence for altered thiamine metabolism in diabetes: Is there a potential to oppose gluco- and lipotoxicity by rational supplementation?

“…Longterm diuretic therapy is known to produce thiamine deficiency [10] . As thiamine deficiency develops, thiamine urinary excretion falls rapidly [12] .…”

Role of Thiamine Deficiency and Efficacy of Thiamine in Treatment of Patients With Heart Failure.

“…Dry beri beri involves peripheral neuropathy that can be permanent even following thiamine repletion. Neurological side effects of thiamine deficiency can progress to Wernicke-koraskoff syndrome 5 .…”