Importance of Serum Selenium Levels in Acute Heart Failure

Document Type: Original Article

Authors

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science. Tehran, IR Iran.

Abstract

Background: The role of micronutrients such as selenium is linked to the different types of cardiomyopathies. Given the paradoxes and limitations of previous studies, we designed a descriptive-analytic study with a greater sample size and more variables in Iran.
 
Methods: Fifty-five patients suffering from heart failure (HF) with glomerular filtration rates of 60 mL/min or higher were selected. At the onset of admission, the serum levels of selenium, proBNP, magnesium, calcium, potassium, and iron, as well as the variable of estimating prognosis (ie, 5 years’ survival based on the Seattle Heart Failure Model calculator), and also a history of diabetes mellitus, hypertension, cerebrovascular accidents, cigarette use, atrial fibrillation, and previous admissions for HF, were registered. Three months later, the New York Heart Association (NYHA) functional class, the left ventricular ejection fraction, and the proBNP level were rechecked.
 
Results:Selenium deficiency (≤ 45µg/L) was detected in 25.4% of the patients. The mean serum level of selenium was 62 ± 24.9 µg/L, and it had no significant relationship with etiology; prognosis; the left ventricular ejection fraction; the proBNP level; the NYHA functional class; the dose of furosemide before admission; the consumption of angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, statins, and allopurinol; laboratory variables; age; sex; diabetes mellitus; hypertension; cerebrovascular accidents; atrial fibrillation; and cigarette use. Nonetheless, the mean serum level of selenium had significant reversed relationships with previous admissions for HF and potassium-sparing diuretic use (P = 0.012 and P = 0.026, respectively) (confidence interval = 95%).
 
Conclusions:The prevalence of selenium deficiency in our patients with HF was considerable. The mean serum level of selenium was similar in both ischemic and nonischemic groups; nevertheless, the level had no significant relationship with the majority of clinical and paraclinical variables of HF severity and prognosis. Future studies should investigate the relationship between the serum level of selenium and the precise cumulative dose of diuretics at the end of the admission process and the interaction between selenium and mineralocorticoid receptors.(Iranian Heart Journal 2020; 21(3): 118-127)

Keywords


  1. Waseem RD. Moving beyond Conventional Heart Failure Treatment-Does Micronutrient Supplementation have a Role? Current Trends in Nutraceuticals. Journal of Nutraceuticals and Food Science. 2016; 1:1.
  2. Shigeru Shibata, Toshiro Fujita. The Kidneys and Aldosterone/Mineralocorticoid Receptor System in Salt-Sensitive Hypertension. Curr Hypertens Rep. 2011 Apr; 13(2): 109115. Published online 2011 Jan 5. doi:10.1007/s11906-010-0175-6 PMCID: PMC3047054
  3. Topuzoglu G, Erbay AR, Karul AB, Yensel N. Concentrations of copper, zinc, and magnesium in sera from patients with idiopathic dilated cardiomyopathy. Biol Trace Elem Res 2003; 95: 11-7.
  4. Rotruck JT, Pope AL, Ganther HE, Swanson AB, Hafeman DG, Hoekstra WG. Selenium biochemical role as a component of glutathione peroxidase. Science 1973; 179: 588-90.
  5. Rayman MP. The importance of Selenium to human health. Lancet 2000; 356(9225): 233-41. DOI: 10.1016/S0140-6736(00)02490-9
  6. Rita Stoffaneller and Nancy L. Morse.  A Review of Dietary Selenium Intake and Selenium Status in Europe and the Middle East. Nutrients. 2015 Mar; 7(3): 1494–1537. Published online 2015 Feb 27. doi: 10.3390/nu7031494 PMCID: PMC4377864
  7. Oldereid NB, Thomassen Y, Purvis K. Selenium in human male reproductive organs. Hum Reprod. 1998 Aug; 13(8):2172-6.
  8. Burk RF, Levander OA. Selenium. In: Shils ME, Olson JA, Shike M, Ross AC - Modern Nutrition in Health and Disease, 9th ed. Baltimore: Williams & Williams, 1999: 265-76.
  9. Lockitch G. Selenium: clinical significance and analytical concepts. Crit Rev Clin Lab Sci 1989; 27: 483-541.
  10. Nazemi L, Nazmara S, Eshraghyan MR, Nasseri S, Djafarian K, Yunesian M, Sereshti H, Moameni A, Shahtaheri SJ, et al. Selenium status in soil, water and essential crops of Iran. Iranian J Environ Health Sci Eng. 2012 Nov 21; 9(1):11.doi: 10.1186/1735-2746-9-11.
  11. Salmani nodoushan MH ,Ehrampoush MH, Askarshahi M, Vakili M. Determining selenium serum level in healthy young couples by furnace atomic absorption. J Shahid Sadoughi Univ Med Sci 2014; 22(4): 1350-57.
  12. Hu XF, Chan HM. Factors associated with the blood and urinary selenium concentrations in the Canadian population: Results of the Canadian Health Measures Survey (2007-2011). Int J Hyg Environ Health. 2018 Aug; 221(7):1023-1031. doi: 10.1016/j.ijheh.2018.07.001. Epub 2018 Jul 7
  13. Suzuki Y, Hashiura Y, Matsumura K, Matsukawa T, Shinoharab A, Furuta N, et al.  Dynamic pathways of selenium metabolism and excretion in mice under different selenium nutritional statuses. Metallomics. 2010 Feb; 2(2):126-32. doi: 10.1039/b915816b. Epub 2009 Dec 23.
  14. Zachara BA.Review article. Selenium and selenium-dependent antioxidants in chronic kidney disease. AdvClin Chem. 2015; 68:131-51. doi: 10.1016/bs.acc.2014.11.006. Epub 2015 Jan 7.
  15. Podracká L, Sasinka M, Rácz O, Sipulová A, Gayová E, Horská M, Boor A, et al. [Relation between metabolism of trace elements and the antioxidant defense system in chronic nephropathies]. Cas Lek Cesk. 1999 May 24; 138(11):337-9.
  16. Oster, O. & Prellwitz, W. The renal excretion of selenium. Biol Trace Elem Res (1990) 24: 119. https://doi.org/10.1007/BF02917201
  17. Dubois F, Belleville F, et al. Review article. Selenium: physiologic role and value in human pathology. Pathol Biol (Paris). 1988; 36(8):1017-1025
  18. Arnaud J, Chappuis P, Clavel JP, Bienvenu F, Favier A. Methods of determination of selenium in biological matter. Ann Biol Clin (Paris). 1986; 44(5):459-69. PMID: 3544972
  19. Navarro M, Lopez H, Ruiz ML, Gonzalez S, Perez V, Lpez MC, et al. Determination of selenium in serum by hydride generation atomic absorption spectrometry for calculation of daily dietary intake. Sci Total Environ 1995 Dec 15; 175(3):245-52.
  20. Muszynska M, Sukiennicki G, Jakubowska A, Lubinski J, et al; Blood and serum samples collection and storage for further selenium measurements. 2012. Hered Cancer Clin Pract. doi: 10.1186/1897-4287-10-S3-A16
  21. da Cunha S, Albanesi Filho FM, da Cunha Bastos VL, Antelo DS, Souza MM. Thiamin, selenium, and copper levels in patients with idiopathic dilated cardiomyopathy taking diuretics. Arq Bras Cardiol. 2002 Nov; 79(5):454-65. PMID:12447496
  22. Oster O, Prellwitz W, Kasper W, Meinertz T. Congestive cardiomyopathy and selenium content of serum. Clin Chim Acta 1983; 128: 125-32.
  23. Auzepy P, Blondeau M, Richard C, Pradeau D, Therond P, Thuong T. serum selenium deficiency in myocardial infarction and congestive cardiomyopathy. Acta Cardiol 1987; 42(3):161-166
  24. Salonen JT, Alfthan G, Huttunen JK, Pikkarainen J, Puska P. Association between cardiovascular death and myocardial infarction and serum selenium in an matched– pair longitudinal study. Lancet 1982 Jul 24; 2(8291):175-9.
  25. Kharrazi H, Heidari R, Kiani A, Sahebjamie F. The Study of Serum Selenium in Myocardial Infarction Patients in Kermanshah (2002). Avicenna J Clin Med. 2005; 12 (2) :10-16
  26. Arroyo M, Laguardia SP, Bhattacharya SK, Nelson MD, Johnson PL, Carbone LD, Newman KP, Weber KT, et al. Micronutrients in African-Americans with decompensated and compensated heart failure. Translational Research. 2006 Dec 31; 148(6):301-8. DOI:10.1016/j.trsl.2006.08.003
  27. Koşar F, Sahin I, Taşkapan C, Küçükbay Z, Güllü H, Taşkapan H, Cehreli S, et al. Trace element status (Se, Zn, Cu) in heart failure. The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi). 2006 Sep 1;6(3):216-21
  28. Witte KK, Nikitin NP, Parker AC, Haehling Sv, Volk HD, Anker SD, Clark AL, Cleland JG, et al. The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure. Eur Heart J. 2005 Nov; 26(21):2238-44.
  29. Hiraoka Y. Nihon Rinsho. Association between function of selenium and heart disease. Nihon Rinsho. 2016 Jul; 74(7):1192-8.
  30. Raygan F, Behnejad M, Ostadmohammadi VR, Bahmani F, Mansournia MA, Karamali F,Asemi A, et al. Selenium supplementation lowers insulin resistance and markers of cardio-metabolic risk in patients with congestive heart failure: a randomised, double-blind, placebo-controlled trial. Br J Nutr. 2018 Jul; 120(1):33-40. doi: 10.1017/S0007114518001253.
  31. Rees K, Hartley L, Day C, Flowers N, Clarke A, Stranges S. Selenium supplementation for the primary prevention of cardiovascular disease. Cochrane Database of systematic Reviews 2013, Issue 1. Art. No.: CD009671. DOI: 10.1002/14651858.CD009671.pub2.
  32. Stefanescu A, Macklin EA, Lin E, Dudzinski DM, Johnson J, Kennedy KF, Jacoby D, Yeh DD, Lewis GD, Yeh RW, Liberthson R, Lui G, Bhatt AB, et al. Usefulness of Seattle Heart Failure Model to identify adults with congenital heart disease at high risk of poor outcome. Am J Cardiol. 2014 Mar 1; 113(5):865-70. Doi:10.1016/j.amjcard.2013.11.043. Epub 2013 Dec 12.