Pathophysiological basis for nutraceutical supplementation in heart failure: A comprehensive review

Vincenzo Mollace, Giuseppe M.C. Rosano, Stefan D. Anker, Andrew J.S. Coats, Petar Seferovic, Rocco Mollace, Annamaria Tavernese, Micaela Gliozzi, Vincenzo Musolino, Cristina Carresi, Jessica Maiuolo, Roberta Macrì, Francesca Bosco, Marcello Chiocchi, Francesco Romeo, Marco Metra, Maurizio Volterrani

Research output: Contribution to journalArticlepeer-review


There is evidence demonstrating that heart failure (HF) occurs in 1–2% of the global population and is often accompanied by comorbidities which contribute to increasing the prevalence of the disease, the rate of hospitalization and the mortality. Although recent advances in both pharmacological and non-pharmacological approaches have led to a significant improvement in clinical outcomes in patients affected by HF, residual unmet needs remain, mostly related to the occurrence of poorly defined strategies in the early stages of myocardial dysfunction. Nutritional support in patients developing HF and nutraceutical supplementation have recently been shown to possibly contribute to protection of the failing myocardium, although their place in the treatment of HF re-quires further assessment, in order to find better therapeutic solutions. In this context, the Optimal Nutraceutical Supplementation in Heart Failure (ONUS-HF) working group aimed to assess the optimal nutraceutical approach to HF in the early phases of the disease, in order to counteract selected pathways that are imbalanced in the failing myocardium. In particular, we reviewed several of the most relevant pathophysiological and molecular changes occurring during the early stages of myocardial dysfunction. These include mitochondrial and sarcoplasmic reticulum stress, insuffi-cient nitric oxide (NO) release, impaired cardiac stem cell mobilization and an imbalanced regulation of metalloproteinases. Moreover, we reviewed the potential of the nutraceutical supplementa-tion of several natural products, such as coenzyme Q10 (CoQ10), a grape seed extract, Olea Europea L.-related antioxidants, a sodium–glucose cotransporter (SGLT2) inhibitor-rich apple extract and a bergamot polyphenolic fraction, in addition to their support in cardiomyocyte protection, in HF. Such an approach should contribute to optimising the use of nutraceuticals in HF, and the effect needs to be confirmed by means of more targeted clinical trials exploring the efficacy and safety of these compounds.

Original languageEnglish
Article number257
Pages (from-to)1-31
Number of pages31
Issue number1
Publication statusPublished - Jan 2021


  • Dysfunctional cardiomyocytes
  • Heart failure
  • Nutraceuticals
  • Oxida-tive stress
  • Patho-physiological mechanisms

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


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