The role of iron, omega-3 Fatty acids, and vitamins in heart failure.

OPINION STATEMENT: The high prevalence of iron deficiency in heart failure (HF), its easy detection, and its rapid treatment effects with intravenous compounds including, among other things, improved New York Heart Association class, quality of life, and exercise capacity, may offer a major new addition to the treatment of HF. Although more research is required in HF, iron deficiency has been recognized as a disease for over a century and there is no question that its correction is desirable for improving the health and the quality of life of the iron-deficient patient. Iron deficiency with or without an associated anemia should be routinely searched for and treated in HF patients. Controlled studies of omega-3 fish oils suggest that they are cardioprotective in HF. They also may have additional value as safe and highly effective analgesics and anti-inflammatory agents in HF patients who often cannot take traditional nonsteroidal agents. The American Heart Association has recently recommended use of fish and/or fish supplements for all patients with cardiovascular disease. However, practical questions remain. For example, it is not clear what the optimal ratio of the two major components of fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), should be in supplements. The role of other vitamins, such as vitamin D, in HF remains unclear.