Heart failure risk is reduced by selenium supplementation

Heart failure is a condition in which the heart no longer performs as well as it should. It affects millions of people in the United States and Europe. Heart failure is characterized by the following symptoms:

• shortness of breath
• build-up of congestion in the lungs
• accumulation of fluid in the lower extremities

What do we know about selenium status and the risk of heart failure?

Prof Urban Alehagen’s KiSel-10 studies and sub-analyses have shown that selenium supplementation of elderly citizens low in selenium reduces the risk of heart disease mortality.
Low serum selenium levels are associated with increased risk of heart failure [Al-Mubarak 2021; Bomer 2020].
Selenium status below 70 mcg/L is regarded as selenium deficiency status [Al-Mubarak 2021; Bomer 2020].
Selenium status below 100 mcg/L is regarded as suboptimal status [Al-Mubarak 2021; Bomer 2020].
Both selenium deficiency and suboptimal selenium status are associated with increased risk of cellular dysfunction, oxidative stress, and chronic low-grade inflammation [Al-Mubarak 2021; Bomer 2020].

What do we know about selenium supplementation and heart failure?

Selenium supplementation of individuals with low selenium status may improve heart function and may reduce the need for hospitalization [Alehagen 2022].
Selenium supplementation of individuals with low selenium status may reduce the oxidative stress and systemic inflammation that increase the risk of heart failure [Alehagen 2022].

Selenium and the Risk of Cardiomyopathy

Myocardium is the medical term for the heart muscle. Cardiomyopathy is a disease or disorder of the heart muscle, often of unknown cause. Keshan disease is a form of cardiomyopathy that develops as a result of selenium deficiency and exposure to a strain of the coxsackievirus. The disease takes its name from Keshan County in northeastern China Its symptoms were first observed there. Keshan disease can result in heart failure [Zhou 2018].

Mechanisms of Selenium Deficiency in Heart Failure

Oxidative stress

Oxidative stress is the condition in which there is an overbalance of harmful free radicals over protective antioxidants. Oxidative stress increases the risk of heart failure [D’Oria 2020].

Oxidative stress damages heart muscle cells.
Oxidative stress aggravates chronic systemic inflammation.
Oxidative stress worsens heart muscle function.

Low selenium status

Inadequate intake of selenium is associated with increased risk of heart failure [Al-Mubarak 2021].

Selenium is a necessary component of selenoproteins with an antioxidant function.
These selenoproteins help to reduce oxidative stress in heart muscle cells.
The antioxidant selenoproteins, e.g., the glutathione peroxidases, protect against the negative effects of oxidative stress.

Chronic systemic inflammation

Chronic systemic inflammation contributes to an increase in the risk of heart failure [Boulet 2024].

Selenoproteins play a role in regulating inflammatory processes.
Adequate selenium intake and status helps to reduce systemic inflammation.

Propositions Concerning Selenium and Heart Failure

In a 2024 doctoral thesis presented at the University of Groningen in The Netherlands, Dr. Ali Ahmad Al-Mubarak has presented the following propositions:

Selenium deficiency is a stronger predictor of heart failure mortality than iron deficiency is.
In over two-thirds of observed heart failure patients, researchers have found low selenium concentrations.
In the general population, individuals who do not smoke and who have optimal selenium status have a lower risk of developing heart failure.
Available research evidence suggests that selenium influences the immune system profile of heart failure patients with optimal selenium status as contrasted with heart failure patients with low selenium concentrations.

Sources

Al-Mubarak AA. Selenium and Heart Failure. Doctoral thesis. University of Groningen, The Netherlands. 2024. ISBN: 978-94-6506-032-3.

Al-Mubarak AA, van der Meer P, Bomer N. Selenium, Selenoproteins, and heart failure: current knowledge and future perspectives. Curr Heart Fail Rep. 2021 Jun;18(3):122-131.

Alehagen U, Johansson P, Svensson E, Aaseth J, Alexander J. Improved cardiovascular health by supplementation with selenium and coenzyme Q10: applying structural equation modelling (SEM) to clinical outcomes and biomarkers to explore underlying mechanisms in a prospective randomized double-blind placebo-controlled intervention project in Sweden. Eur J Nutr. 2022 Sep;61(6):3135-3148.

Bomer N, Grote Beverborg N, Hoes MF, Streng KW, Vermeer M, Dokter MM, IJmker J, Anker SD, Cleland JGF, Hillege HL, Lang CC, Ng LL, Samani NJ, Tromp J, van Veldhuisen DJ, Touw DJ, Voors AA, van der Meer P. Selenium and outcome in heart failure. Eur J Heart Fail. 2020 Aug;22(8):1415-1423.

Boulet J, Sridhar VS, Bouabdallaoui N, Tardif JC, White M. Inflammation in heart failure: pathophysiology and therapeutic strategies. Inflamm Res. 2024 May;73(5):709-723.

D’Oria R, Schipani R, Leonardini A, Natalicchio A, Perrini S, Cignarelli A, Laviola L, Giorgino F. The Role of oxidative stress in cardiac disease: from physiological response to injury factor. Oxid Med Cell Longev. 2020 May 14;2020:5732956.

Zhou H, Wang T, Li Q, Li D. Prevention of Keshan disease by selenium supplementation: a systematic review and meta-analysis. Biol Trace Elem Res. 2018 Nov;186(1):98-105.

The information presented in this review article is not intended as medical advice. It should not be used as such.

Milestones in early selenium research

1817 Swedish chemist Jöns Jakob Berzelius discovers selenium

1957 Biochemist Klaus Schwarz shows that selenium in microscopic amounts has a vital importance for mammalian health

1969 Professor J.T. Rotruck discovers that selenium has a biochemical role as a component of the antioxidant enzyme glutathione peroxidase

1969 Professors R.J. Shamberger and D.V. Frost report a possible protective effect of selenium against cancer in humans

1973 Professor J.T. Rotruck identifies the enzyme glutathione peroxidase as a selenium-dependent protein

1977 Professor G.N. Schrauzer publishes cancer mortality correlation studies showing an inverse correlation between dietary intakes of selenium and cancer mortality in 27 countries

1988 Professor G.Q Yang summarizes the lessons learned about the selenium-related endemic diseases Keshan disease and Kashin-Beck disease and about the importance of adequate daily selenium intakes

1989 Professor G.G. Duthie publishes evidence for a role of selenium in the prevention of cardiovascular disease

1993 Researcher W.J. Blot publishes the results of the Nutrition Intervention Trials in Linxian, China, showing that supplementation with a combination of selenium and other antioxidants reduces the risk of cancer

1994 Professor G.N. Schrauzer publishes evidence that selenium is important in the maintenance and therapy of HIV-infected patients

1996 Professor Larry Clark publishes the results of a randomized controlled trial – the Nutritional Prevention of Cancer study -- that shows selenium's cancer-protective effects on colon cancer, lung cancer, and prostate cancer

1997 Professor G.F. Combs summarizes the evidence for the protective effects of selenium against cancer

1999 Professor J.E. Oldfield publishes his Selenium World Atlas, mapping areas of selenium deficiency around the world

2000 Researcher O.A. Levander publishes evidence showing an anti-viral effect of selenium

2002 Researcher R. Gärtner shows that supplementation with selenium reduces inflammation in patients with autoimmune thyroiditis

2002 Researcher Margaret Rayman presents the arguments for increasing selenium intakes to realize selenium’s antioxidant and anti-viral and anti-inflammatory effects as well as selenium’s enhancement of immune function and reproductive success.