{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T15:33:12Z","timestamp":1776439992523,"version":"3.51.2"},"reference-count":232,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,17]],"date-time":"2021-01-17T00:00:00Z","timestamp":1610841600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","award":["03PE000_78"],"award-info":[{"award-number":["03PE000_78"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>There is evidence demonstrating that heart failure (HF) occurs in 1\u20132% 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 requires 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, insufficient nitric oxide (NO) release, impaired cardiac stem cell mobilization and an imbalanced regulation of metalloproteinases. Moreover, we reviewed the potential of the nutraceutical supplementation of several natural products, such as coenzyme Q10 (CoQ10), a grape seed extract, Olea Europea L.-related antioxidants, a sodium\u2013glucose 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.<\/jats:p>","DOI":"10.3390\/nu13010257","type":"journal-article","created":{"date-parts":[[2021,1,20]],"date-time":"2021-01-20T03:34:25Z","timestamp":1611113665000},"page":"257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Pathophysiological Basis for Nutraceutical Supplementation in Heart Failure: A Comprehensive Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0392-7173","authenticated-orcid":false,"given":"Vincenzo","family":"Mollace","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe M. C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"Cardiology Clinical Academic Group, St George\u2019s Hospitals NHS Trust University of London, London SW17 0QT, UK"},{"name":"Department of Cardiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J. S.","family":"Coats","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petar","family":"Seferovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Belgrade University, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7106-5595","authenticated-orcid":false,"given":"Rocco","family":"Mollace","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"},{"name":"Department of Experimental and Applied Medicine, Institute of Cardiology, University of Brescia, 25121 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annamaria","family":"Tavernese","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"},{"name":"Department of Experimental and Applied Medicine, Institute of Cardiology, University of Brescia, 25121 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micaela","family":"Gliozzi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Musolino","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Carresi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Maiuolo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Macr\u00ec","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Bosco","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Institute of Research for Food Safety &amp; Health, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Chiocchi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, 00199 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Romeo","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00199 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Department of Experimental and Applied Medicine, Institute of Cardiology, University of Brescia, 25121 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-9213","authenticated-orcid":false,"given":"Maurizio","family":"Volterrani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ehf2.12005","article-title":"Heart failure: Preventing disease and death worldwide","volume":"1","author":"Ponikowski","year":"2014","journal-title":"ESC Heart Fail"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijcard.2010.04.055","article-title":"Incidence and mortality of heart failure: A community-based study","volume":"151","author":"Andrey","year":"2011","journal-title":"Int. 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