Invited Review

Heart failure (HF) is the leading cause of morbidity and mor-tality in industrialized countries.1 Anorexia, malnutrition, elderly age, frequent hospitalizations, premature satiety, and disease severity are among the factors identified as contribut-ing to reduced dietary intake and subsequently increased risk of nutrient deficiency in patients with HF.2-8 Furthermore, diuretics are routinely prescribed to patients with HF to man-age fluid overload.9 However, these medications are linked with increased urinary losses of electrolytes and micronutri-ents, potentially contributing to the development of nutrient deficiencies in this population.10-12 Dietary factors may play a role in disease outcomes in patients with HF; however, there are few investigations of the micronutrient status of patients with HF.13,14 Several studies have demonstrated widespread micronutrient deficiency, including B vitamins, in patients with HF.5,6,10,15-20 Because the majority of B vitamins act as cofactors in the production of cellular energy,21 a deficiency of one or more of these vitamins could contribute to the depletion of energy reserves observed in the failing heart.6 Despite advances in therapeutic approaches to the man-agement of HF, this disease continues to remain a costly and burdensome condition on both patients as well as on the healthcare system.22 Moreover, most drug regimens are associated with side effects and have limited safety and effi-cacy.23,24 Because nutrient supplementation represents a potentially cost-effective and readily available adjunct therapy, it is important to understand the link between micronutrient status and disease pathogenesis and treat-ment. Therefore, the aim of this review is to summarize the existing literature regarding the B vitamin status of patients with HF as well as any studies exploring the potential ben-efits of supplementation in the management of HF