Selenium has beneficial effects on the prevention and treatment of heart failure. Higher serum selenium levels are associated with a lower risk of new-onset heart failure and with a lower risk of mortality. Now, data from a 2024 cohort study suggest that strengthened immune system function may be a mechanism that explains the positive effect of selenium [Al Mubarak 2024].
In the study, Al Mubarak et al analyzed the data from a cohort of 2,328 patients diagnosed with heart failure. Heart failure is the medical term to describe patients with a heart muscle that cannot pump as much blood out to the tissues and organs as it should. The heart is too weak or too stiff to fill up with blood and pump out blood optimally. Heart failure is frequently associated with a build-up of fluid in the lungs – causing shortness of breath – and in the lower extremities. The bottom line is that heart failure can be life-threatening [Mayo Clinic Staff 2025].
The mean age in the cohort was 68.8 years. The mean serum selenium level was 89.1 mcg/L. The researchers divided the heart failure patients into quartiles and observed the following low and high mean serum selenium levels [Al Mubarak 2024].
- Q1: 60.6 mcg/L (lowest quartile
- Q4: 122.0 mcg/L (highest quartile)
What characterized the patients with the lower circulating levels of selenium?
- were older
- were more likely to be female*
- were more likely to have higher circulating NT-proBNP levels
- were more likely to have a higher inflammatory profile
*Note: Sexual dimorphism is defined as differences in males and females beyond the differences in their sex organs. It is not surprising that selenium biology displays significant sexual dimorphism [Seale 2018].
Serum Selenium Levels in Heart Failure Patients
In the patients with heart failure, the researchers found an association between serum selenium concentrations and several immunoregulatory processes. These processes included the regulation of leukocytes and T lymphocyte activation and differentiation.
In a related in vitro study using human peripheral blood mononuclear cells (PBMCs), the researchers observed an overall reducing of cytokine concentrations in selenium-supplemented cultures compared to cultures without selenium supplementation.
In the immune system, cytokines facilitate the proliferation and differentiation of immune cells. They enhance the activities of lymphocytes and phagocytes. Quite often, it is the cytokines that are unbalanced in heart failure patients [Hanna 2020].
In their in vitro study using human PBMCs, Al Mubarak et al showed a significantly lower abundance of pro-inflammatory cytokines in the selenium-supplemented cultures compared to the non-supplemented cultures. Given selenium supplementation’s effect on the abundance of cytokines in patients with heart failure, the researchers concluded as follows [Al Mubarak 2024]:
- Selenium supplementation may modulate the immune responses.
- Selenium supplementation may optimize the functionality of immune cells.
- Selenium supplementation may stimulate cardio-protective processes.
Heart failure patients have generally lower concentrations of circulating selenium. They have a dysregulated immune response and a chronic state of inflammation. Accordingly, they are more vulnerable to infections requiring hospitalization. Consequently, studies of the effect of selenium supplementation on heart function and cardiovascular mortality are of particular interest [Al Mubarak 2024].
The KiSel-10 Study of Selenium and CoQ10 Supplementation
In the context of the research done by Al Mubarak et al, it is interesting to summarize here the outcomes of the KiSel-10 randomized controlled trial [Alehagen 2013]. In the study, Alehagen et al recruited elderly community living Swedish citizens, average age 78 years. At the start of the study, the participants were deficient in selenium (baseline mean selenium level of 67.1 mcg/L) and sub-optimal in CoQ10 (baseline mean CoQ10 level of 0.82 mg/L).
Combined daily supplementation with 200 mcg selenium from selenium-enriched yeast and 2 x 100 mg of a patented ubiquinone supplement for 48 months resulted in the following outcomes [Alehagen 2022]:
- improved heart function
- reduced cardiovascular mortality
- reduced levels of biomarkers of oxidative stress
- reduced levels of biomarkers of chronic inflammation
- reduced levels of biomarkers of fibrosis
- reduced levels of biomarkers of endothelial dysfunction
Conclusion: Selenium and Heart Failure
Higher serum selenium concentrations are associated with less inflammation, better heart health, and lower cardiovascular mortality.
Higher serum selenium concentrations are associated with reduced levels of pro-inflammatory cytokines.
Regulation of the immune system may be a mechanism by which selenium status affects heart failure patients.
Sources
Al-Mubarak AA … van der Meer P, Bomer N. Biomarker and transcriptomics profiles of serum selenium concentrations in patients with heart failure are associated with immunoregulatory processes. Redox Biol. 2024 Apr;70:103046.
Alehagen U, Johansson P, Björnstedt M, Rosén A, Dahlström U. Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Int J Cardiol. 2013 Sep 1;167(5):1860-6.
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.
Hanna A, Frangogiannis NG. Inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020 Dec;34(6):849-863.
Mayo Clinic Staff. Heart Failure. 21 January 2025. Retrieved from
https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Seale LA, Ogawa-Wong AN, Berry MJ. Sexual dimorphism in selenium metabolism and selenoproteins. Free Radic Biol Med. 2018 Nov 1;127:198-205.
The information presented in this review article is not intended as medical advice. It should not be used as such.