L12-Heart Failure

Question 1

List NHPs discussed in this lecture

Answer 1

1. PUFAs
2. Coenzyme Q-10
3. Vit D
4. Vit E
5. Hawthorn
6. Herbal diuretics
7. L-carnitine
8. L-arginine

Question 2

Concerns w/ NHPs & HF

Answer 2

• Potential for bleeding or clotting
  • NHPs can increase or decrease BP
  • NHPs can cause/exacerbate fluid retention
  • Stimulants (e.g. weight loss products)
  • On drugs with narrow therapeutic index (eg. Digoxin)
  • NHPs with diuretic properties can cause hypokalemia
  • Dehydration with stimulant laxatives (diarrhea)

Question 3

1. PUFA
   List some.
   Which ones are beneficial?

Answer 3

ALA, DHA, EPA
Beneficial ones= DHA, EPA
NS: fish oil, flax seed, canola oil, soybeans

Question 4

1. PUFA

MOA?

Answer 4

May reduce risk of coronary outcomes and overall mortality by:

1. Lower triglyceride levels (at higher doses)
2. Prevent serious arrthymias
3. Decrease platelet aggregation (but maybe only at higher doses)
4. Lower blood pressure
5. Lower resting heart rate

Question 5

1. PUFA

safety?

Answer 5

Generally well tolerated 3-4 g/day
• AE: “fish burp”, halitosis, heartburn, dyspnea, nausea, loose stools and rash
• Proposed benefit shown in baked/broiled, not fried

Question 6

1. PUFA

O3 Canada’s Food Guide & American Heart Association recommendation

Answer 6

consumption of 2+ portions of fish per week for 1 and 2ndary prevention of CVD

Question 7

1. PUFA

CCS HF guideline update recommends:

Answer 7

We suggest O3 PUFA therapy at a dose of 1 g daily
be considered for reduction in morbidity and cardiovascular mortality in patients with HFrEF
(Weak Recommendation, Moderate Quality Evidence)

Question 8

2. Coenzyme Q-10

Describe

Answer 8

Vitamin-like
compound found in the body: found in high conc.
in the mitochondria
of the heart, liver & kidney
NS: meats & seafood (small amounts)

Question 9

2. Coenzyme Q-10

MOA?

Answer 9

• helps w/ the prod’n of ATP & inhibition of ATP production can cause cell death and tissue damage.
• HF pt have lower serum levels & replacing might improve cellular energy production and prevent cell death in people with HF.

Question 10

2. Coenzyme Q-10

Other uses.

Answer 10

prevent statin-induced myopathies, prevent doxorubicin-induced cardiotoxicity, immune stimulation in HIV/AIDS pts, and treatment of muscular dystrophy.

Question 11

2. Coenzyme Q-10

safety?

Answer 11

no toxicity, but conducted in an era where ACEi, BB, MRAs NOT STD HF tx
SE: GI

Question 12

2. Coenzyme Q-10

DIs?

Answer 12

1. Warfarin (decreased effect due to structural similarity to Vitamin K)
2. Potentiate the anti-hypertensive effects of some blood pressuring lowering drugs

Question 13

3. Vit D

Why?

Answer 13

-ppl w low levels have signif increased risk of developing cdv disease, including HF (compared to those w higher)
for now, advise pts to get appropraite amount of Vit D, but dont recommend specifically to tx HF (but also no harm)

Question 14

4. Vit E

T/F: Vit E has no role in HF

Answer 14

TRUE
pts on Vit E had higher risk of developing HF and HF hospitalization
-> 50% increase in chronic HF hospitalization or death in pts w LV dysfunction
->high doses may increase all-cause mortality

Question 15

5. Hawthorn

Answer 15

• cardiac glycoside like dig
• long hx of use in cdv disease (some countries is 1st Rx product)
• pharm effect comes from flavonoids found in leaf, fruit, or flower of these plants

Question 16

5. Hawthorn

Answer 16

• note: dig can decrease hosp, but not mortality
• > hawthorn may be similar to dig in MOA;
• can have pos inotroph effects and increased CO ; VD effects (dont use w nitrates)
• can affect bp, contractility (can decrease bp and hr; watch with other anti-HTN)
• not recommended in HF (but not rigorously studied)